When people compare Original Medicare and Medicare Advantage Plans, it’s essential to know which services are covered and which are not. Preventative services are an important aspect to focus on when comparing plans, as regular screenings can help detect or mitigate illnesses in the early stages.
As you do your research, you’ll find Medicare Part B, one-half of Original Medicare, and Medicare Advantage Plans both cover many preventative services. Still, some may only be covered by a Medicare Advantage Plan but not Original Medicare. With that in mind, let’s discuss 7 preventative services covered by both Medicare Part B and Medicare Advantage and some services that are not.
Why is Preventative Care Important?
Preventative care is an essential part of staying healthy. Some may argue that it is the most important thing you can do to manage your health.
Preventative care promotes disease prevention and offers early detection services. This proactive approach means a little time spent with your doctor for yearly check-ins could save you a lengthy hospital visit down the road. Research shows time and time again that treatment works best if started in the early stages of a disease. That’s why it’s essential to follow through on the preventative care procedures recommended by your doctor. And with Medicare Part B and Medicare Advantage, many of those preventative services are covered.
What is Medicare Part B?
Medicare Part B is the medical insurance component of Medicare. It covers medically necessary services from doctors and other health care providers, hospital outpatient care, durable medical equipment, and home health care.i
It also covers various preventative services to help maintain your health and keep certain illnesses from getting worse. Keep reading to learn about the different preventative services covered under Medicare Part B.
What is Medicare Advantage?
Medicare Part C, more commonly known as Medicare Advantage Plans, includes all benefits and services covered under Medicare Part A and Part B, and usually includes Medicare prescription drug coverage (Part D) as part of the plan.
Medicare Advantage is run by Medicare-approved private insurance companies and these plans may include extra benefits and services for an additional cost.
7 Preventative Services Covered by Medicare Part B and Medicare Advantage
Initial “Welcome to Medicare” visit
Medicare Part B and Medicare Advantage Plans cover an initial appointment with a physician. During the appointment, you’ll have the opportunity to discuss your medical history and any health issues that occur in your family. You’ll go through routine measurements like weight, height, and blood pressure and receive a personal assessment for your health. This is a great opportunity to meet with a doctor to discuss any concerns or issues. You’ll leave the appointment with any preventative care screening recommendations and a list of risk factors and treatment options. This initial meeting will set the stage for your health journey on Medicare and should leave you feeling comfortable and confident about the quality of care you receive.ii
Medical screenings are another preventative service covered by Medicare Part B and Medicare Advantage. Most screenings are covered, including cancer screenings, cardiovascular screenings, diabetes screenings, and sexually transmitted disease screenings. They also include select mental health preventative services like depression screenings. It’s important to have any recommended screenings completed to prevent any major issues from occurring.
Shots are also covered by Medicare Part B and Medicare Advantage. Your annual flu shot falls under a preventative service, as do others, like Pneumonia. Take full advantage of this service and get all the shots your doctor recommends.
You may be surprised to learn that many counseling services are covered by both Medicare Part B and Medicare Advantage. Some examples include alcohol misuse counseling, obesity counseling, tobacco use cessation counseling, and sexually transmitted disease counseling. Under Medicare Part B and Medicare Advantage, you can get the counseling assistance you need to regain control of your health and make positive changes.
Annual wellness visits
In addition to your yearly flu shot, an annual wellness visit is covered by Medicare Part B and Medicare Advantage. This is a critical part of maintaining your health which happens once every 12 months. Take the time to meet with your doctor to ensure that you stay on track. Your visit will be similar to your initial “Welcome to Medicare” appointment. This is a great time to discuss any changes in your medical history and mention any issues or health concerns to your doctor.iii If necessary, your doctor may suggest completing another preventative service item on this list to prioritize and sustain your health.
It’s important for women to have annual pap/pelvic exams. These vital services are covered by Medicare Part B and Medicare Advantage.iv Mammograms are also covered.
There may be a time when your doctor requests you complete lab work as a way to check on or verify your health. These lab tests are covered by Medicare Part B and Medicare Advantage. Lab tests can provide critical information about your health and are an important preventative service.
3 Additional Preventative Care Services Provided by Medicare Advantage
In addition to the preventative services listed above, Medicare Advantage Plans may also cover the following items depending on the plan:
Annual routine physical exams
While annual wellness visits are covered by Medicare Part B, annual routine physical exams are not. These visits are more comprehensive than a wellness visit and involve a physical examination to screen for disease or potential risk factors. The appointment may include a heart exam, lung exam, and neurological exam.
This additional preventative service is beneficial for maintaining your health and may be available depending on the Medicare Advantage Plan you select.
Some Medicare Advantage Plans cover annual physicals for their members for free of charge.v Check with your plan to see if yours includes this benefit before agreeing to a routine physical by your doctor.
Dental and vision care
While Medicare Part B covers many preventative services, it doesn’t provide coverage for dental or vision care. Medicare Advantage Plans can include dental and vision care in addition to the items listed above. Medicare Part B only covers dental or vision procedures if they’re an integral part of a covered procedure, such as jaw reconstruction following an injury. By receiving routine dental and vision care, you can help prevent more significant problems from occurring down the road.
Sometimes, the key to preventative care is being on the appropriate medication to maintain your health. Medicare Part B does not cover the cost of prescriptions, but many Medicare Advantage Plans do. If you require prescription drugs, make sure your Medicare Advantage Plan includes drug coverage or enroll in a separate Prescription Drug Plan to supplement your Original Medicare Plan.
Preventative care is an essential part of taking care of your health. Thankfully, a wide variety of preventative services are covered under Medicare Part B and Medicare Advantage.
The above list is a great starting point to help you learn about the services covered by Medicare Part B and Medicare Advantage. However, there is so much more to learn. The better you understand Medicare Part B and Medicare Advantage, the more you can use the benefits available to you to your advantage.
If you’re interested in learning more about the Medicare Advantage Plans available in your area, please call the number on this page to speak with an Ensurem licensed insurance agent.
Don’t want to speak to an agent, then Emma is here to help. Emma is your virtual Medicare assistant1 and can help you compare plans and enroll in Medicare Advantage plans 100 percent online with no need to speak to an agent.
1Emma is a virtual assistant and is not a live person.
i “What Part B Covers,” Centers for Medicare and Medicaid Services, Medicare.gov, https://www.medicare.gov/what-medicare-covers/what-part-b-covers
ii “’Welcome to Medicare’ Preventative Visit,” Centers for Medicare and Medicaid Services, Medicare.gov, https://www.medicare.gov/coverage/welcome-to-medicare-preventive-visit
iii “Yearly ‘Wellness’ Visit,” Centers for Medicare and Medicaid Services, Medicare.gov, https://www.medicare.gov/coverage/yearly-wellness-visits
iv “Cervical & Vaginal Cancer Screenings,” Centers for Medicare and Medicaid Services, Medicare.gov, https://www.medicare.gov/coverage/cervical-vaginal-cancer-screenings
v “Costly Confusion: Medicare’s Wellness Visit Isn’t The Same As An Annual Physical,” Michelle Andrews, March 20, 2019, Kaiser Health News, https://khn.org/news/medicare-covers-wellness-visit-not-annual-physical/