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When Putting Preventive Care Into Practice, How Much Does Medicare Cover?

Although Medicare covers a long list of health care services, the program also leaves a fair amount of gaps – and unfortunately, many of these come in the area of preventive care. There are, however, some services that the Medicare program will cover. Therefore, it is important to have a good understanding of which part of Medicare covers what type of care.

Medicare preventive careIn determining just exactly what is covered, it is important to first consider whether or not you will meet the basic eligibility criteria – and this will depend upon various factors. For example:

  • Original Medicare – For those who have Original Medicare coverage (Medicare Part A and Medicare Part B), there is no deductible or coinsurance amount that is required with certain types of preventive care services that are recommended by the United States Preventive Services Task Force, provided that you see either a doctor or other health care provider that accepts Medicare assignment. However, even though the preventive care service itself may be free, there is a chance that you could be charged for additional services that are related to such care. These charges could include the following:
  1. There may be certain charges for some preventive care services if your health care provider makes a diagnosis during the services or if additional testing or procedures are performed. Such testing or procedures may be done if it is found that you have specific symptoms of a condition or if you have a history of a particular condition. In addition, charges may also apply if during your wellness visit, your doctor needs to either treat or do additional investigation on a new or existing health issue that you have.
  2. You may also be charged for a doctor’s visit if you meet with a physician for other reasons before or after your wellness visit.
  3. In addition, a facility fee could apply, depending on where your services are received. As an example, certain hospitals oftentimes charge fees when individuals come in to obtain preventive health care services.

Also, Original Medicare may also still require you to pay the normal amount of its deductible and / or coinsurance for certain preventive care services. Some of these   services may include diabetes self-management trainings and screenings for glaucoma.

  • Medicare Advantage – For those who have a Medicare Advantage plan, your plan will not be allowed to charge you for any of the preventive care services that are free to the enrollees in Original Medicare – provided that you use an in-network provider for such services. If, however, you use out-of-network providers for your preventive care services, your plan may be allowed to charge you.

In any case, it is essential to closely follow the guideline that Medicare has established for receiving your preventive care services. This will help you to ensure that Medicare will cover the services that are supposed to be covered and that you are not required to pay more for not following the proper procedures.

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