Medicare For Dummies. Patricia Barry

(I go into the difference between national coverage determinations, which cover people in need of them throughout the country, and other coverage determinations that are made regionally, in Chapter 14.) But on the whole, Medicare pays for a vast range of medical services that people need.

      

I’ve heard from people who’ve used a lot of services, or a few really expensive ones, and are scared to death that their Medicare coverage is going to “run out.” This isn’t something to worry about. In general, no limit caps the amount of coverage you can get from Medicare for necessary services — except for a few specific situations that I explore later in this chapter.

      Preventive care

      Being able to treat a medical problem is good, but dodging it altogether is better! These days, that seems an obvious truth. Yet Medicare has only fairly recently expanded coverage for services that help prevent or stave off some of the diseases that make people very ill and — not coincidentally — cost Medicare mountains of money. Even better: Many of these preventive tests, screenings, and counseling sessions now come free (no co-pays or deductibles) thanks to the 2010 Affordable Care Act. As of 2020, some 44 million people with Medicare took advantage of these services, at no cost to themselves, according to government reports.

      

But to get these services for free, you need to see a doctor who accepts assignment — meaning that she has agreed to accept the Medicare-approved amount as full payment for any service provided to a Medicare patient. (I go into detail about what Medicare doctors can charge in Chapter 13.) Otherwise, you have to pony up a co-pay or, in some circumstances, even the full cost.

Now take a look at Table 2-1, which shows the range of preventive tests, screenings, and counseling sessions that Medicare covers under Part B and whether they cost you anything. It’s a pretty impressive list!

TABLE 2-1 Preventive Care Services Medicare Covers

Service	Frequency Covered	Cost to You
“Welcome to Medicare” checkup	Once only, during first 12 months in Part B.	Free, but any other tests the doctor refers you for may require a co-pay.
Wellness checkup	Once every 12 months, after you’ve had Part B for one year.	Free as long as you ask for a wellness visit and not a “physical.”
Abdominal aortic aneurysm screening	One-time ultrasound for people at risk.	Free.
Alcohol misuse screening and counseling	One screening and up to four counseling sessions a year.	Free.
Bone mass measurements	Once a year if you’re at risk for broken bones; more if medically necessary.	Free.
Breast cancer screening (mammograms)	Once a year for women age 40 or older.	Free.
Cardiovascular disease (behavioral therapy)	Once a year.	Free.
Cardiovascular disease screening	Once every five years.	Free for the tests, but a co-pay is usually required for the doctor visit.
Cervical/vaginal cancer screening	Once every 24 months, or every 12 months if you’re at high risk.	Free.
Colorectal cancer screening — barium enema (when used instead of flexible sigmoidoscopy or colonoscopy)	Once every 48 months, or every 24 months if at high risk.	A co-pay is required.
Colorectal cancer screening — colonoscopy	Once every 120 months, or every 24 months if at high risk.	Free for the test, but a co-pay is required if a polyp is found and removed during the test.
Colorectal cancer screening — fecal occult blood test	Once every 12 months if you’re 50 or older.	Free.
Colorectal cancer screening — flexible sigmoidoscopy	Once every 48 months if you’re 50 or older.	Free.
Depression screening	Once a year in a primary-care setting.	Free screening, but a co-pay is required for doctor visit and follow-up care.
Diabetes training	Training on how to self-manage diabetes — up to 12 hours in the first year and up to two hours every year after that.	A co-pay is required, and your Part B deductible applies.
Diabetes screening	Up to two screenings a year if you’re at risk of developing diabetes.	Free.
Flu shots	Once a year in flu season.	Free.
Glaucoma (eye disease) tests	Once every 12 months if you’re at high risk.	A co-pay is required, and your Part B deductible applies.
Hepatitis B virus (HPV) infection screening	Annually only for those considered at risk who don’t get a Hepatitis B vaccination.	Free.
Hepatitis C screening test	One-time screening; yearly screening for people at high risk or those born between 1945 and 1965.	Free.
HIV screenings	Once every 12 months or up to three times during pregnancy.	Free.
Lung cancer screening	Once a year for people age 55–77, who are current or former smokers averaging one pack a day for 30 years, but without symptoms of lung disease.	Free.
Obesity screening and counseling	Behavioral counseling sessions if your body mass index (BMI) is 30 or higher.	Free.
Pneumococcal shot	After age 65, one type of shot followed at least one year later