Benefit Bulletin: April/May 2013

Benefit Bulletin: April/May 2013

"Free" Medicare Preventive Services May Not Be

Medicare materials give the impression that "You pay nothing for most preventive services," but that's not always the case. To qualify, you must meet certain guidelines. Here are four important questions to ask. We zero in on colorectal cancer screenings, to illustrate, but the same questions below apply to any preventive service.

  • How often should I be getting this test? Medicare coverage depends on meeting recommended frequency rules. That can be tough for almost anyone to figure out, especially when there are several types of screenings for the same health problem, each requiring different frequencies to qualify. There are four different types of colorectal cancer screenings, each with different recommended frequencies. Sooner or later your doctor will likely recommend one. Of those, colonoscopies, for example, are covered once every ten years, unless you are at high risk for colorectal cancer, when they are covered more frequently.
  • What is the recommended age for this service? Medicare's material say, "People of any age are eligible for a colonoscopy." While you may be eligible, there could be out-of-pocket costs. Routine colonoscopies, for example, are not considered necessary once you are over the age of 75 — unless you are at high risk or have a condition that would require the test. If you are over the age of 75 get your screening cleared in advance with your health plan.
  • Does your doctor accept assignment? Does your doctor accept assignment or Medicare's payment in full? Fewer doctors do these days, and whether you have any additional co-pays or co-insurance also depends on your health plan. It's a good idea to check with your health plan to learn about your coverage and costs for the service.
  • Did the screening visit result in the biopsy or removal of a growth? If a colonoscopy resulted in the removal of one or more polyps, you can have potentially significant out-of-pocket costs for removal and anesthesia.

Learn more about Medicare preventive services online at or call your Medigap or Medicare Advantage plan to learn what costs you can expect.