Medicare.gov says you pay nothing for most preventive services if you get them from a provider who accepts assignment. But if your provider does additional tests or services during the same visit that aren't covered under the preventive benefit, you may owe coinsurance, and the Part B deductible may apply. A common example is a screening colonoscopy where a polyp is removed: Medicare.gov says you then pay 15% of the Medicare-approved amount for the doctor's services, plus a 15% coinsurance to the facility in a hospital outpatient setting or ambulatory surgical center.
What preventive services does Medicare cover?
Medicare.gov lists many preventive services, including:
- The "Welcome to Medicare" preventive visit.
- The yearly "Wellness" visit.
- Screenings for some cancers, like colorectal and prostate cancer screenings.
- Vaccines, including flu, pneumococcal, hepatitis B, and COVID-19 shots.
- Some counseling and other screenings.
Medicare.gov says you pay nothing for most of these if your provider accepts assignment.
Why did I get a bill after a preventive visit?
The visit turned into a problem visit. Medicare.gov's wellness visit page says coinsurance and the Part B deductible may apply if your provider performs additional tests or services during the same visit that Medicare doesn't cover under the preventive benefit. For example, if you bring up a new problem, like knee pain, and the doctor examines and treats it, that part may be billed as a regular office visit.
You got a routine physical. The yearly wellness visit isn't a head-to-toe physical exam. Medicare.gov says if Medicare doesn't cover additional tests or services, like a routine physical exam, you may have to pay the full amount.
A screening became diagnostic. A screening colonoscopy is covered at no cost, but if the doctor removes a polyp, you pay 15% coinsurance for the doctor's services and, in a hospital outpatient setting or ambulatory surgical center, 15% to the facility, according to Medicare.gov.
The provider doesn't accept assignment. The "you pay nothing" rule depends on assignment.
Lab work or tests outside the preventive benefit. Some blood tests ordered at a wellness visit aren't preventive services.
What isn't charged for colonoscopies anymore?
Medicare.gov says that if your provider accepts assignment, you pay nothing for the screening test, including a follow-up colonoscopy after a positive result from a Medicare-covered blood-based biomarker test or stool-based test.
How do I avoid surprise preventive care bills?
- When you book, say what kind of visit you want. "I'm scheduling my yearly Medicare wellness visit."
- Ask before extra tests. "Is this test part of my free preventive visit, or will it be billed separately?"
- Bring up new problems knowing they may be billed. You can still bring them up, but ask whether it will be a separate charge, or schedule another visit.
- Check that the provider accepts assignment.
Medicare.gov also notes that your doctor may recommend services Medicare doesn't cover or covers less often, and suggests asking why and what Medicare will cover.