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.
Costs may differ for Medicare Advantage plans, the other main type of Medicare. These plans are offered by private insurers that contract with the federal Medicare program and generally come with their own set of benefits, as we explain further in “14 Added Benefits in the New Medicare Advantage Plans.”
Following are services available to Medicare recipients that could save you money and help prevent costly health problems.
1. Part A premiums
The component of Medicare called Part A primarily covers hospital stays and inpatient care (whereas Part B primarily covers services in health care providers’ offices).
Most people don’t have to pay a monthly premium for Part A coverage so long as they paid Medicare payroll taxes during their working years.
Specifically, premium-free Medicare Part A is available to people age 65 and older if they are eligible for or already receive retirement benefits from Social Security or the Railroad Retirement Board. It’s also available to anyone of that age who had Medicare-covered government employment or had a spouse with Medicare-covered government employment.
2. ‘Welcome to Medicare’ preventive visit
Not to be confused with an annual wellness visit, the “Welcome to Medicare” preventive visit available without an out-of-pocket cost must occur within the first 12 months after someone begins their Medicare Part B coverage.
During this one-time visit, a health care professional will provide information on preventive services covered by Medicare and possibly make referrals for other care based on a review of your medical and social background.
3. Annual wellness visit
The purpose of the annual wellness visit available to Medicare recipients 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 among covered preventive benefits.
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 describes as any type of infection caused by Streptococcus pneumoniae bacteria. These can include pneumonia, meningitis and sepsis.
Vaccines for hepatitis B may also be covered, depending on your risk.
5. Cancer screenings
Medicare covers screenings for a variety of health conditions. They include various types of cancer:
- Colorectal cancer — one colonoscopy every 24 or 120 months, depending on your risk
- Lung cancer — one low-dose computed tomography scan, or lose-dose CT scan, every year for certain current and former smokers ages 55 to 77
- Cervical and vaginal cancer — includes a Pap test, pelvic exam as well as a breast exam every 12 or 24 months, depending on your risk
- Prostate cancer — includes a prostate-specific antigen (PSA) blood test every 12 months for men over age 50
Some cancer screenings have eligibility requirements, while others do not.
6. Mental health screenings
When it comes to mental health, Medicare provides the following free screenings:
- Alcohol misuse — one screening per year, if you use alcohol but aren’t considered dependent on it
- Depression — one screening per year
7. Other health screenings
Beyond cancer and mental health screenings, Medicare provides a number of free screenings for other health conditions. They include the following, most of which are free if you meet certain risk factors:
- Abdominal aortic aneurysm — one screening in your lifetime
- Cardiovascular disease — blood tests every five years
- Diabetes — up to two screenings per year
- Hepatitis C — up to one screening per year
- HIV — up to three screenings per year
- Obesity — one initial screening
- Sexually transmitted infections — screenings once per year
The following types of counseling are among those 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
9. Bone density tests
Also known as bone mass measurements, these tests help determine whether you are at risk for broken bones. They are free to eligible Medicare recipients every 24 months, or more often if medically necessary. To qualify, you must meet one or more of the following criteria:
- Be a woman deemed estrogen-deficient and at risk of osteoporosis by a doctor.
- Have X-rays that show possible osteoporosis, osteopenia or vertebral fractures.
- Take prednisone or steroid-type drugs.
- Be diagnosed with primary hyperparathyroidism.
- Be on osteoporosis drug therapy that must be monitored for effectiveness.
10. Cardiovascular behavioral therapy
Once a year, Medicare provides a free cardiovascular behavioral therapy visit with a primary care provider.
This visit is intended to help people reduce their risk of cardiovascular disease and includes a blood pressure check as well as tips about healthy eating. Taking aspirin daily may also be discussed.
11. Diabetes management training
Those who are diagnosed with diabetes have access to free self-management training.
Offered on an outpatient basis, this training occurs mainly in a group setting and covers topics such as monitoring blood sugar, eating healthfully and administering medication.
Medicare will pay for up to 10 hours of initial training and, in some cases, two hours of follow-up training every subsequent year.
12. Nutrition therapy
Those with diabetes or kidney disease or who have had a kidney transplant within 36 months are eligible for free medical nutrition therapy. Covered services may include an initial nutrition and lifestyle assessment, individual and group therapy and follow-up visits.
13. The ‘What’s Covered’ app
In 2019, Medicare debuted a free app called “What’s Covered.” You can use the app to look up medical goods and services and find out whether Medicare covers them.
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.
14. 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 their local State Health Insurance Assistance Programs (SHIP).
The U.S. Department of Health and Human Services funds SHIPs through grants to states. There is a SHIP for every state as well as the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands.
A SHIP 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.
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