If you already have Medicare or will soon, you must know the basics of what it covers. However, how much do you really know about the hidden benefits that are included with Medicare health insurance coverage?
They aren’t really free, because the Medicare program itself isn’t exactly free. These included services don’t have any out-of-pocket costs for most Medicare beneficiaries. It’s worth mentioning that there might be some caveats.
For instance, there could be some limitations on frequency, and your healthcare provider needs to accept the program’s payment conditions. But it’s still worth it, especially if you have Original Medicare, the government-provided benefit system, which is one of the two main types of Medicare.
Costs could differ for Medicare Advantage plans, which are the other type of Medicare. These plans are generally offered by private insurers that work with the federal Medicare program and come with their own set of benefits besides all the other Medicare-required services. Here’s how you can save money and help prevent expensive health issues!
Part A premiums
The component of Medicare called Part A mainly covers hospital stays and impatient care. However, Part B covers services not only in outpatient facilities but also in physician offices. The vast majority of people don’t even have to pay a monthly premium for Part A coverage, just as long as they or their partner paid Medicare payroll taxes throughout their working years.
As a general rule, you have to work and pay your taxes for a minimum of 10 years to avoid paying Part A premiums. Premium-free Part A is also available for you if you qualify for it before the age of 65.
“Welcome to Medicare” preventive visit
Don’t confuse this with an annual wellness visit, as the “Welcome to Medicare” preventive visit, which is free, needs to happen within the first 12 months after someone starts their Medicare Part B coverage.
During this one-time visit, a healthcare professional might provide additional information on preventive services covered by the program and even make referrals for other care, depending on the review given by your medical and social background.
Annual wellness visit
Medicare recipients are also entitled to a free annual wellness visit. This is meant to develop or even update a more personalized plan that would prevent disease and disability, depending on your health situation.
The visit could also include a review of your medical and family history, developing or updating an entire list of your health care providers and prescriptions, routine measurements like height, weight, and blood pressure, detection of any cognitive impairment, and additional personalized health advice.
Vaccines
One influenza shot for every flu season is covered when you have Medicare, and so are the COVID-19 vaccine and booster. A total of two pneumococcal shots are covered as well. These vaccines successfully keep pneumococcal disease away from you, which is any kind of infection caused by Streptococcus pneumonia bacteria.
These can also include pneumonia, meningitis, or sepsis. Also, vaccines for hepatitis B could be covered, depending on the risk. The Inflation Reduction Act of 2022 made more vaccines available to Medicare beneficiaries without any kind of cost-sharing. These vaccines are highly recommended by a federal panel of experts known as the Advisory Committee on Immunization Practices.
Cancer screenings
Medicare covers screenings for a wide variety of health conditions. They could also include different types of cancer, including:
- Colorectal cancer: one colonoscopy every 24, 48, or even 120 months, assessed depending on the risk;
- Lung cancer: one low-dose computed tomography scan, or even a low-dose CT scan, on a yearly basis;
- Cervical and vaginal cancer: includes a Pap test and pelvic exam but also a clinical breast exam every 12 to 24 months, depending on the risk;
- Prostate cancer includes a prostate-specific antigen (PSA) blood test every 12 months for senior men over 50;
Mental health screenings
When it comes to mental health, Medicare offers the following free screenings: alcohol misuse, which is one screening per year if you consume alcohol but aren’t considered dependent, or depression, which is one screening per year.
Other health screenings
Besides cancer and mental health screenings, Medicare also offers a number of free screenings for other serious health conditions. Here’s a list of some of the things you should expect (it’s worth mentioning that most of them are free if you meet certain risk factors):
- abdominal aortic aneurysm: one screening in a lifetime;
- cardiovascular disease: blood tests every five years;
- diabetes: two screenings per year;
- hepatitis C: one screening per year;
- HIV: up to three screenings;
- Obesity: one initial screening;
- se*ually transmitted infections: screenings once per year.
Counseling
These types of counseling are among those offered free by Medicare for people who are eligible for alcohol counseling (which covers up to four sessions per year) and smoking and tobacco counseling (which covers up to eight sessions in a 12-month period).
Bone density tests
Commonly known as bone mass measurements, these tests help establish whether you are at risk for broken bones. They are also free to eligible Medicare recipients every 24 months, or more often if required. If you want to see if you qualify, you need to meet one or more of the following criteria:
- being a woman diagnosed with estrogen-deficiency and at risk of osteoporosis;
- having X-rays that show possible osteoporosis, osteopenia, and vertebral fractures;
- taking prednisone or steroid-type drugs;
- being diagnosed with primary hyperparathyroidism;
- being on osteoporosis drug therapy that needs to be monitored for effectiveness.
Cardiovascular behavioral therapy
Medicare offers a free cardiovascular behavioral therapy visit with a primary care provider every year. This visit is meant to help people reduce the risk of cardiovascular disease. It also includes a blood pressure check and a couple of tips about healthy eating. For example, taking aspirin on a daily basis might be mentioned.
Diabetes management training
Those who are diagnosed with diabetes are allowed access to free self-management training. Offered on an outpatient basis, this type of training takes place mainly in a particular group setting and covers all kinds of topics, like monitoring blood sugar, eating better, and administering medication.
Medicare might be able to pay for up to 10 hours of initial training. In some instances, there are two hours of follow-up training every subsequent year.
Nutrition therapy
Those who suffer from diabetes or kidney disease and have had a kidney transplant within 36 months are eligible for free medical nutrition therapy. Covered services might also include an initial nutrition and lifestyle assessment, individual but also group therapy, and follow-up visits.
The “What’s Covered” app
In 2019, Medicare debuted a free app called “What’s Covered.” You can easily use the app to check medical goods and services and also to find out whether Medicare covers them. If you don’t want the app or don’t have access to a smartphone or internet-connected tablet, you might use a computer to access it. It will let you search for an item or service and also find out whether it’s covered or not.
Insurance assistance
People who are eligible for Medicare, as well as their families and caregivers, have full access to free, in-depth, one-on-one insurance counseling and assistance from their local State Health Insurance Assistance Program.
The U.S. Department of Health and Human Services is directly funding the program through grants to each state. There is a SHIP in every state, but also in the District of Columbia, Puerto Rico, Guam, and the United States Virgin Islands.
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