In February 2025, the White House established a new health commission with a monumental task: to better address the alarming prevalence of chronic disease in the United States.¹

This work is more important now than ever. Millions of Americans age 65 and older live with one or more chronic conditions including obesity, heart disease, high cholesterol, and depression. And here at NCOA, we’re all too familiar with the real people behind these numbers—people who bear heavy physical, mental, and financial burdens because of their illnesses.

People like Michele Tedder, whose struggles with her weight stretch back decades into her childhood. People like Ms. Kim, who suffered silently with grief-related depression due to stigmas around mental health and getting screened. And people like Martha N., who—at age 60—is willing yet unable to work due to the many impacts of living with diabetes, high blood pressure, and arthritis. You, or someone you know, may even share their company.

“We know that certain lifestyle changes—like getting more exercise and eating a healthier diet—can help avoid, or better manage, many of these conditions,” said Gretchen Dueñas-Tanbonliong, Associate Director of Health and Wellness at NCOA. “Regular screenings at the doctor’s office can identify them early and keep them from getting worse. And yet, our traditional medical model focuses more on treating existing illnesses than preventing new ones.”

This is a missed opportunity. According to the Centers for Disease Control and Prevention (CDC), chronic diseases account for most illness, disability, and death in the United States and are the leading drivers of health care costs.² Efforts to prevent and manage them save money and improve quality of life.

The commission recognizes this, too. To fully address America’s health care crisis, its foundational document calls for “more flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes and disease prevention.”¹

In many ways, Medicare already fits the bill. If you’re surprised to hear this, you’re not alone. 

That’s why we’ve put together this primer on Medicare preventive services. And that’s why we’ll continue to advocate tirelessly on your behalf for this important benefits program that provides health coverage for more than 68 million Americans.³

Understanding Medicare preventive benefits

You might think of Original Medicare (Parts A and B) as health insurance that pays for your doctor’s visits, hospital stays, and any medically necessary tests and services you might get while there. This is true. And: Medicare also goes beyond medical management to include health promotion and preventive care services that many people aren’t fully aware of.

Generally speaking, “preventive services” describes a wide variety of care you can get to stay healthy and reduce the chances you’ll get sick or develop a disability. Yearly checkups, vaccinations, and regular vision and dental care are just a few examples. Medicare includes many more.

What are Medicare preventive services?

It might be easiest to think about these in terms of “buckets.” Medicare has 6 preventive services buckets, each of which holds a variety of specific benefits they will pay for. The list includes:

• Wellness visits
  These include certain annual doctor’s visits; initial physical preventive exams; and the official Medicare Wellness Visit.
• Shots and vaccines
  These include immunizations against pneumonia; Hepatitis B; the flu; and COVID.
• Tests and screenings
  This comprehensive list includes—but isn’t limited to—abdominal aortic aneurism ultrasound; bone density measurement; cardiovascular screening; glaucoma tests; mammography; and prostate cancer exams.
• Diabetes-related services
  These include blood sugar measurements; glucose challenge testing; and self-care resources, among other things.
• Counseling and therapies
  These include screenings and counseling for alcohol misuse; tobacco use prevention and cessation; behavioral therapy for cardiovascular disease and obesity; and medical nutrition therapy for diabetes and kidney disease.
• Mental health services
  This includes screening for depression and may also cover certain behavioral health and wellness services such as cognitive assessment; alcohol and opioid use treatment; marriage and family counseling; individual and group psychotherapy; and many others.

Who qualifies for Medicare preventive services?

You must be enrolled in Medicare Part B (medical insurance) to get these benefits.⁴ If you belong to a Medicare Advantage Plan, you qualify for preventive services as well.

While the minimum age for Medicare is 65, younger people with certain disabilities or conditions also can enroll. (For more information on qualifying for Medicare, see “What is Medicare and How Do I Get Started?”).

Once you’re enrolled, most—if not all—of Medicare’s preventive services will cost you nothing. “This is a tremendous perk,” explained Ryan Ramsey, NCOA’s Associate Director of Health Coverage and Benefits. “Medicare isn’t free. Premiums, deductibles, and other out-of-pocket costs quickly can add up. Using these preventive care services is good for your health and your wallet. It potentially could save you money in the long run.”

Of course, certain rules and coverage exceptions apply. For example, your doctor or other health care provider must “accept assignment” for preventive services. This means they agree only to charge the fee that Medicare will pay.⁵ (Some providers don’t accept assignment and will bill extra for services; you can check ahead of time to avoid unexpected costs). Some screenings only are available for people with specific risk factors. (Your doctor can help you understand whether or not you meet the criteria). And Medicare Advantage Plans may have network rules that dictate which providers you can see. (Your plan documents should describe these rules).

What preventive services are not covered by Medicare?

Original Medicare doesn't pay for most dental, vision, and hearing care. That includes visits for teeth cleaning, X-rays, eye exams, and other typical preventive services. (Some Medicare Advantage Plans do cover these extra benefits, offered in addition to what original Medicare provides; check your documents to see if yours does).

• Here are some other things Medicare doesn’t cover⁶:
• Care provided outside the United States (even if it’s preventive)
• Chiropractic care
• Cosmetic and elective surgery
• Immunizations (see “Shots and vaccines” above for exceptions)
• Routine annual checkups (except the Medicare Wellness Visit)
• Tests or screenings that are medically unreasonable or unnecessary

What else is not covered under Medicare preventive care benefits?

Sometimes, your doctor will want to run more tests—or order additional care—after your preventive visit. For example, if your bone mass measurement is abnormal, you may need to take a prescription drug for osteoporosis. Or, if your colonoscopy screening shows that you have cancerous growths, you may need surgery or chemotherapy.

This additional care is not considered preventive. Medicare still may cover a portion of the fees, but you will be responsible for any deductibles or other out-of-pocket costs if they apply.

If you’re enrolled in Medicare Part B, click through to “Is your test, item, or service covered?” for more information. If you’re enrolled in a Medicare Advantage Plan, you can check your “Evidence of Coverage” (EOC) for details on how much you pay. And remember: you always can ask your health care provider to explain any additional costs before you agree to further treatment.

The bottom line

Medicare preventive services are good for your health and your budget. Using these no-cost benefits can help you avoid or better manage illness and chronic disease that otherwise might take a tremendous toll on your quality of life and financial security. Think of it as a paycheck you give yourself—one of many investments you can make in your personal longevity portfolio. 

Sources

1. The White House. Establishing the President’s Make America Healthy Again Commission. February 13, 2025. Found on the internet at https://www.whitehouse.gov/presidential-actions/2025/02/establishing-the-presidents-make-america-healthy-again-commission/

2. Centers for Disease Control and Prevention. Fast Facts: Health and Economic Costs of Chronic Conditions. July 12, 2024. Found on the internet at https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html

3. Centers for Medicare & Medicaid Services. Medicare Monthly Enrollment. August 2024. Found on the internet at https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment

4. Centers for Medicare & Medicaid Services. Your Medicare Coverage. Preventive and screening services. Found on the internet at https://www.medicare.gov/coverage/preventive-screening-services

5. Centers for Medicare & Medicaid Services. Your Guide to Medicare Preventive Services. Found on the internet at https://www.medicare.gov/publications/10110-your-guide-to-medicare-preventive-services.pdf

6. Centers for Medicare & Medicaid Services. Items & Services Not Covered Under Medicare. July 2024. Found on the internet at https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/items-and-services-not-covered-under-medicare-booklet-icn906765.pdf