Table of Contents:

    1. Which Preventive Services Does Original Medicare Cover?
    2. Terms of Service
    3. Preventive Services Through Medicare Advantage

Your health depends on more than just your ability to see a doctor and get treatment when things go wrong. As explained by the University of Tennessee Medical Center, “most types of medicine focus on treating an illness or injury, rather than keeping it from happening. But preventive (care) stops sickness before it starts.” Preventive services (also called preventative services) consist of healthcare that is proactive rather than reactive. This includes things like tests, screenings, immunizations, counseling, and behavioral therapy (for example, smoking cessation services).

The Centers for Disease Control and Prevention (CDC) defines chronic illnesses as “conditions that last 1 year or more and require ongoing medical attention, or limit activities of daily living, or both.” According to the AARP, 4 out of 5 American adults aged 50 and above suffer from at least one chronic illness or disorder. Chronic illnesses can range from chronic acid reflux to diabetes and heart disease. Treating a chronic illness after it arises is often an exercise in symptom mitigation, since these conditions tend to be difficult to cure completely. A major purpose of preventive treatment is to determine what illnesses (chronic and otherwise) you may be at risk for, so that you can work with your doctor to avoid developing them in the first place. In the long run, preventive care can keep you healthier – while simultaneously taking a large burden off of the healthcare system – through disease prevention.

Which Preventive Services Does Original Medicare Cover?

Original Medicare covers a limited list of preventive services. This covered care consists largely of tests, screenings, and immunizations. More specifically, Original Medicare covers preventive services including flu shots, prostate cancer screenings, mammograms, obesity screenings and counseling, and behavioral therapy for cardiovascular disease, among other services. Read this brochure for a comprehensive breakdown of each preventive service that Original Medicare covers. Notably, Original Medicare covers COVID-19 vaccination.

Original Medicare also provides coverage for a one-time preventive visit, which you must use within your first 12 months of signing up for the program. Additionally, it covers a yearly “wellness visit.” Your doctor will check your vitals and conduct a risk assessment during this examination.

Terms of Service

The preventive services offered by Original Medicare are limited both in number and frequency with which you can use them. For instance, cardiovascular blood tests are covered by Original Medicare, but only once every five years.

The Original Medicare payment structure for preventive care can also be complex. For example, Original Medicare covers the full cost of an annual mammogram screening for a woman over the age of 40, but covers only part of the Medicare-approved cost for many diagnostic tests. If an abnormality is found during the $0-out-of-pocket mammogram and you wish to have it further investigated, you must pay for 20% of the cost of the diagnostic test, which may be less than your provider’s full charge. You may have to pay more, too, if you have yet to meet your deductible.

Preventive Services Through Medicare Advantage

As you can see, simply being covered by Original Medicare for a service does not mean that it’s easy to afford. If you are looking for a more comprehensive preventive care package that will present fewer out-of-pocket expenses, it may be worth looking into a Medicare Advantage plan. Medicare Advantage (also referred to as Medicare Part C or MA) is an “all-in-one” alternative to Original Medicare that is offered by private companies, though these companies must be certified by and contract with the CMS. These plans include everything that is covered by Original Medicare as well as various extra benefits. Because Medicare Advantage plans are offered privately, these extra benefits and their price will vary from plan to plan. In 2021, the average Medicare Advantage plan costs $21/month (in addition to the price of Original Medicare, which is built into the cost).

One example of an extra benefit covered by many MA plans is a gym membership. The reasoning behind this is simple: by covering the cost of a service that keeps you healthier in the long run, a provider is helping you stay healthy and, therefore, less likely to need treatment for any conditions, disorders, or illnesses you may develop. By partnering with a plan provider that sees your good health as an investment, you save money, the plan provider saves money, the healthcare system avoids burden, and, most importantly, you may be able to stay healthy without breaking the bank.

Information adapted from the Centers for Medicare and Medicaid Services and Medicare.gov

Additional data and cost information adapted from The University of Tennessee Medical Center, The Centers for Disease Control and Prevention, and The American Association of Retired Persons Public Policy Institute 

Preventive Medicine: Prevention vs. Treatment, 2020. The University of Tennessee Medical Center

About Chronic Diseases, 2020. The Centers for Disease Control and Prevention

Chronic Condition Prevalence in the 50+ US Population, 2012. AARP Public Policy Institute