If you have Medicare or will soon, you probably know the basics of what it covers. But how much do you know about all the lesser-known benefits that are included with Medicare health insurance coverage?
They aren’t exactly free, because Medicare isn’t free. But these included services have no out-of-pocket costs for many Medicare beneficiaries.
There are some caveats. For example, there may be limitations on frequency, and your health care provider must accept Medicare’s payment conditions. Still, it’s worth knowing these benefits are in your pocket if you have Original Medicare, which is one of the two main types of Medicare plans.
Costs may differ for Medicare Advantage plans — the other main type of Medicare plan — because they are offered by private insurers and generally come with their own set of benefits, as we explain further in “7 Facts You Need to Know About Medicare.”
1. Annual wellness visit
The purpose of the annual wellness visit is to develop or update a personalized plan to help prevent disease and disability based on your health situation.
According to Medicare.gov, the official government website for Medicare, the visit might also include:
- A review of your medical and family history
- Developing or updating a list of your health care providers and prescriptions
- Routine measurements — such as height, weight and blood pressure
- Detection of cognitive impairment
- Personalized health advice
Just note that costs such as a deductible might apply if during an annual visit you receive additional tests or services that aren’t covered preventive benefits.
The following types of counseling are among those covered by Medicare for people who meet eligibility requirements:
- Alcohol counseling — up to four sessions per year
- Smoking and tobacco counseling — up to eight sessions in a 12-month period
- Cardiovascular behavioral therapy visits — one per year
While the first two types of counseling are intended to help a patient quit alcohol or tobacco, which are moves with extensive health benefits, cardiovascular behavioral therapy is targeted at helping you lower your risk of developing heart disease.
“During therapy, your doctor may discuss aspirin use (if appropriate), check your blood pressure, and give you tips to make sure you’re eating well,” says Medicare.gov.
Medicare covers screenings for a variety of health conditions. They include screenings for:
- Cardiovascular disease — one blood test every five months
- Colorectal cancer — one colonoscopy every 24 or 120 months, depending on your risk
- Depression — one screening per year
- Diabetes — up to two screenings per year
Some screenings have eligibility requirements, while others do not.
One influenza shot per flu season is free.
A total of two pneumococcal shots are also covered. These vaccines protect against pneumococcal disease, which the U.S. Centers for Disease Control and Prevention describe as any type of infection caused by Streptococcus pneumoniae bacteria.
Vaccines for hepatitis B may also be covered, depending on your risk.
5. The ‘What’s Covered’ app
Medicare recently debuted a free app called “What’s Covered,” which is available for Apple and Android devices. You can use the app to look up other items and services and find out whether Medicare covers them.
“The app delivers general cost, coverage and eligibility details,” says Medicare.gov.
If you don’t want to download the app or don’t have a smartphone or internet-connected tablet, you can use a computer to access Medicare.gov’s Your Medicare Coverage tool, which also lets you search for an item or service and find out whether it’s covered.
6. Insurance assistance
People who are eligible for Medicare as well as their families and caregivers have access to free in-depth, one-on-one insurance counseling and assistance from State Health Insurance Assistance Programs (SHIPs)
SHIPs are funded by grants that the U.S. Department of Health and Human Services (HHS) makes to states, according to the HHS Administration for Community Living. There is a SHIP for every state as well as the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands.
SHIPs can be especially helpful during open enrollment season, although they offer various other services besides one-on-one assistance with reviewing your Medicare plan options. They can also:
- Answer questions about what Medicare does and does not cover.
- Tell you about out-of-pocket cost assistance programs for which you might be eligible.
- Help you understand Medicare’s eligibility criteria.
- Explain how Medicare coverage works in conjunction with supplemental insurance policies, Medicaid and other forms of health insurance.
To find the SHIP for your state, visit the national SHIP website or call 877-839-2675.
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