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Questions about Medicare Prevenative Services and The ACA?

Health Care Reform: Medicare Preventive Services

The Patient Protection and Affordable Care Act (PPACA), makes changes to the preventive services covered at no cost-sharing for Medicare beneficiaries.

As of Jan. 1, 2011, Medicare beneficiaries are no longer required to pay any out-of-pocket costs for most preventive services. Medicare also covers the cost of an annual wellness visit with a physician.

Preventive Services

Medicare covers a number of preventive services at no cost-sharing to the beneficiary, some of these services include:

  • Mammograms every 12 months for eligible beneficiaries age 40 and older
  • Cardiovascular disease screenings
  • Colorectal cancer screening, including flexible sigmoidoscopy or colonoscopy
  • Cervical cancer screening, including a Pap smear test and pelvic exam
  • Cholesterol and other cardiovascular screenings
  • Diabetes screening
  • Medical nutrition therapy to help manage diabetes or kidney disease
  • Prostate cancer screening
  • An annual flu shot and the hepatitis B vaccine
  • Bone mass measurement
  • Abdominal aortic aneurysm screening to check for a bulging blood vessel
  • HIV screening tests for those who are at an increased risk or who request to receive the test
  • Medicare will expand the coverage of additional preventive services at no cost-sharing to the beneficiary as new services, tests or screenings become available and are recommended by the U.S. Preventive Services Task Force.

Annual Wellness Visit

In addition to an initial preventive visit when becoming a beneficiary, Medicare covers an annual wellness visit with a physician to develop a personalized prevention plan that takes a comprehensive approach to improving your health.

Specifically, the wellness visit covers the following services at no cost-sharing to the beneficiary:

  • Routine measurements such as height, weight, blood pressure, body-mass index or waist circumference, if appropriate
  • Review of medical and family history, including medications and current care by other health care providers
  • A personal risk assessment, including any mental health conditions
  • A review of functional ability and level of safety, including an assessment of any cognitive impairment and screening for depression
  • Any other advice or referral services that may help intervene and treat potential health risks
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