I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?

Question

Steve Wilson · Accepted Answer

Medicare covers preventive services that per the Medicare.gov website are identified as exams, shots, lab tests, and screenings.  They key benefit that Medicare does not specifically cover are Routine Physical Exams.  The majority of Medicare Advantage plans do cover a routine annual exam and typically they are a $0 copay.  

It is really important when setting up a routine physical exam with your doctor or provider that you have a good understanding of what services will be provided.  For example, lets say your Medicare Advantage plan covers the routine physical exam which would include all of the $0 copay screenings, shots, and lab tests covered by Medicare. Those items would be a $0 copay.  I never use the word free and Medicare does not allow a broker to ever use the word free.

It is common though that a good provider will ask you if there are other things you would like to discuss during your visit.  Those items could be outside of the routine exam and you might have a copay for that portion of your visit.  Lets say for example that you wish to discuss shoulder or knee pain you have been having.  Those discussions are generally beyond your preventive $0 copay services and could trigger a copay for you.

In conclusion, its important to know that Medicare encourages all consumers to stay healthy and obtain the preventive services that have a $0 copay.  It would only be services beyond or outside of the routine physical exam, tests, labs, screening that you might see additional costs.

Steven Bleicher · Answer

Depending on your chosen company and if you opted for a Supplement or an Advantage plan, there are 2 code #’s that a billing department person will code the treatment that was provided. If you made the appointment due to some pain you are feeling, then that is to be coded as “diagnostic” while a visit without pain is coded as “preventive”. Though, if during an annual checkup, the doctor discovers a “problem”, then the visit will change to a diagnostic code, even though it began as a preventive code. All doctor visits are covered by Medicare Part B at an 80% rate. The remainder of 20% is paid partially by the secondary insurance you have. If a new procedure has been done in a hospital, then Medicare Part A pays the 80% and the secondary again does the 20% in the same manner as above.

Answered by Steven Bleicher on April 10, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Steve Brauer · Answer

There should be no copay for preventative services with Medicare, or with any health plan for that matter. That was addressed with the beginning of the Affordable Care Act, or in slang terms ObamaCare.

Answered by Steve Brauer on April 8, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Gary Henderson · Answer

Preventative screenings are covered under Medicare and no charge. They want you to stay healthy! So your annual wellness visit mammograms pap smears colonoscopies things of that nature that would help prevent disease are covered

Answered by Gary Henderson on April 19, 2025

Agent Licensed in TX, AK, AL & 46 other states

Answered by Gary Henderson Medicare Insurance Agent

Vachik Chakhbazian · Answer

With Original Medicare (Parts A & B) and Medicare Advantage plans, many preventive services are covered at no cost to you. These include screenings, vaccines, and counseling services aimed at preventing or detecting health problems early.

Answered by Vachik Chakhbazian on April 10, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Sam Silva · Answer

free :  Annual Wellness Visit

If a preventive service leads to additional tests, treatments, or a diagnosis, you may have to pay.

I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?

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I keep hearing about free preventive services with Medicare. What exactly is free and what will I still pay for?

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