Medicare Preventive Services – Avoiding Pitfalls

With the introduction of the Affordable Care Act in 2010, Medicare now offers a wide range of disease prevention, detection and treatment services to prevent complications. This shift towards preventive health care is seen as a way to reduce future spending on chronic illnesses and diseases and to further protect Medicare’s trust fund. Get a 2019 medicare supplement plan at to save money

There are over 20 preventative tests and services covered by Medicare that are excluded from any deductible, co payment or co insurance. This means that if you use these services correctly, you can spend $ 0.


In recent years, I have had some clients who were unknowingly billed for services that they believe fall under the guidelines of preventive medicine.

Here are some of the ‘pitfalls’ that some of my clients have experienced while performing these services:

  • You must use an in-Network Provider to perform these services if you have a Medicare Advantage Plan. Otherwise, you’re going to have expenses.
  • Know the risk factors and the frequency that Medicare has set for these tests. Some of the preventative services are only allowed for certain risk groups and many tests are not insured annually for free.
  • Colonoscopy screenings can become outpatient surgeries easily without you ever knowing which co insurances and co payments are affected. If the removal of polyps becomes necessary during the check-up, you may be responsible for the repayment and co-insurance for an outpatient surgery.
  • Annual Medicare ‘wellness’ visits with your doctor are different from a routine annual physical exam. Make sure your doctor knows that you are planning your annual Medicare wellness visit.
  • Medicare beneficiaries have an annual flu vaccine. Those who go to clinics or pharmacy sometimes pay a flat fee to get a flu shot outside a doctor’s office. Make sure the off-site clinics are joining Medicare and claiming your insurance. If this is not the case, you may want to look for another website that will make the job easier and cheaper.
  • Medicare now allows and pays for the new digital 2-D mammography in conjunction with the traditional 3-D mammogram. valid from 1 January 2015.
  • Screening for glaucoma is available to risk groups every 12 months. However, unlike Medicare, coverage is for the screening and treatment of cataract, surgery to treat glaucoma is not a Medicare-covered service. The implication is that Medicare does not pay the cost of glaucoma surgery.

There is a wealth of information available online or through annual Medicare guides sent to beneficiaries that list all the preventative services covered by Medicare.

Medicare recognizes the crucial role which healthcare providers play in providing and informing Medicare beneficiaries about potentially life-saving prevention services and checkups.

While Medicare now pays more preventive care, many Medicare beneficiaries do not fully realize that using prevention services and screening can enable them to live healthier and longer lives in the end. An insurance agent in the healthcare industry makes sure that their clients understand the importance of prevention, early detection, and lifestyle changes that enable a healthier life.



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