Preventive care is the care you receive to prevent illness, detect medical conditions, and keep you healthy. If you meet the eligibility requirements and guidelines for a preventive service, Part B of Original Medicare or your Medicare Advantage Plan must cover that service.
Under Original Medicare, you pay nothing (no deductible or coinsurance) for preventive services recommended by the U.S. Preventive Services Task Force if you see a health care provider who takes assignment.
If you have a Medicare Advantage Plan and you see an in-network provider, you pay nothing for preventive services that are covered with zero cost-sharing by Original Medicare, as long as you meet Medicare’s eligibility requirements for the service.
In some cases, you may be charged for services you receive related to your preventive service, even if the preventive service itself is covered at 100% of the Medicare-approved amount. During the course of your preventive visit, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit. You also may be responsible for paying a facility fee, depending on where you receive the service.
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This content was created and copyrighted by the Medicare Rights Center ©2019. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.