Key Takeaways
- Medicare Part B covers most preventive screenings, vaccines, and annual wellness visits at $0 cost-sharing when you see a participating provider.
- The Annual Wellness Visit is not the same as a routine physical — knowing the difference prevents surprise bills.
- Screenings for cancer, diabetes, cardiovascular disease, and depression are included, with eligibility rules tied to age or risk factors.
- Vaccines covered include flu, COVID-19, hepatitis B, and pneumococcal shots — all at no cost under Part B.
- Referrals generated during a preventive visit may trigger standard Part B cost-sharing, so always ask before your doctor orders additional services.
- Beneficiaries who use preventive benefits regularly detect conditions earlier and typically face lower long-term out-of-pocket costs.
Why Part B Preventive Coverage Matters More Than Most Enrollees Realize
If you are enrolled in Medicare Part B, you are already paying a monthly premium — $174.70 in 2024 for most beneficiaries. Yet study after study shows that a significant share of Part B enrollees never use the preventive services they are entitled to, often because they simply don't know those services exist or assume they'll cost extra. That assumption can be an expensive mistake.
Part B's preventive benefit is one of the most underappreciated features of original Medicare. Under federal law, Medicare must cover a broad list of screenings, counseling sessions, vaccines, and wellness visits — and for the vast majority of these services, your out-of-pocket cost is zero. No deductible. No coinsurance. Nothing, as long as you see a Medicare-participating provider and the service is delivered in a qualifying setting.
Understanding which services are covered — and under exactly what conditions — is how you turn passive enrollment into active protection. This guide walks through every major category of covered preventive services, explains the eligibility rules in plain language, and flags the most common billing pitfalls that can convert a free visit into an unexpected bill.
For a broader look at how Part B differs from Part A, see our full comparison of Parts A and B before diving in here.
The list below covers the ten most important categories of preventive services under Part B. Read through all of them — you may discover benefits you didn't know you had.
The "Welcome to Medicare" Preventive Visit
Within the first 12 months of enrolling in Part B, you are entitled to a one-time "Welcome to Medicare" preventive visit — also called the Initial Preventive Physical Examination (IPPE). This is a foundational appointment, and it's entirely free when you see a participating provider.
Here's what the IPPE covers:
- A review of your medical and family history
- Blood pressure, height, weight, and body mass index measurement
- Vision and hearing screening
- A review of your current medications and potential risk factors
- Referrals for any additional screenings or counseling Medicare covers
- An electrocardiogram (EKG) — though note this is only covered if ordered at the IPPE, not as a standalone preventive test
One important rule: you must schedule this visit within the first 12 months of your Part B effective date. Miss that window, and you lose access to it permanently. It doesn't roll over or reset. So if you are newly enrolled, put this appointment on your calendar immediately.
The IPPE is also a smart setup for everything else on this list — your provider uses it to build a personalized prevention plan that directs you to the specific screenings you qualify for.
Miss your Welcome to Medicare visit deadline and you lose it permanently — schedule it the moment you enroll.
Annual Wellness Visit (AWV)
Once you've been enrolled in Part B for at least 12 months, you become eligible for an Annual Wellness Visit (AWV) every year — again, at no cost to you. This is the benefit most people think of as their annual physical, but it's technically something different and more limited.
The AWV is a health risk assessment, not a comprehensive physical exam. It does not include hands-on clinical exams like listening to your heart or examining your abdomen. What it does include:
- Update of your medical history and current medications
- Blood pressure measurement
- Cognitive impairment detection screening
- Review of functional ability and level of safety (such as fall risk)
- Development of a personalized prevention plan
- Depression screening
The AWV is genuinely valuable because it creates a documented prevention roadmap — essentially a checklist of which screenings you need and when. But the distinction from a physical matters: if you want a hands-on exam, that's a separate visit subject to normal Part B cost-sharing.
[in_content_images:1]A common billing issue occurs when a beneficiary arrives for an AWV and the physician transitions the appointment into a sick visit or diagnostic evaluation. Ask your provider at the start of the appointment to keep the visit focused on the wellness assessment only if you want to protect your $0 cost status.
The Annual Wellness Visit creates your prevention roadmap — but it's not a physical exam, and that distinction affects your bill.
Cancer Screenings
Part B covers several cancer screenings, each with its own eligibility criteria and frequency schedule. Here's a straightforward breakdown:
| Screening | Who Qualifies | Frequency |
|---|---|---|
| Colorectal cancer (colonoscopy) | All Part B enrollees age 45+ | Every 10 years (average risk); every 2 years (high risk) |
| Colorectal cancer (flexible sigmoidoscopy) | All Part B enrollees age 50+ | Every 4 years |
| Colorectal cancer (stool-based tests) | All Part B enrollees age 45+ | Annually (FIT/gFOBT); every 1–3 years (stool DNA) |
| Mammogram | Women age 40+ (screening); all ages (diagnostic) | Annually |
| Cervical and vaginal cancer (Pap smear / pelvic exam) | All women with a cervix | Every 24 months; annually for high-risk individuals |
| Prostate cancer (PSA test) | Men age 50+ | Annually |
| Lung cancer (low-dose CT) | Age 50–77, current or former smoker (20+ pack-year history, quit within 15 years) | Annually |
One nuance worth knowing: if a colonoscopy is scheduled as a preventive screening but polyps are discovered and removed during the same procedure, Medicare may reclassify part of the procedure as therapeutic — which can trigger cost-sharing. Ask your gastroenterologist about this in advance so you're not surprised by a bill afterward.
A preventive colonoscopy that finds and removes polyps may be partially reclassified as therapeutic, potentially triggering cost-sharing.
Cardiovascular Disease Screenings and Counseling
Heart disease remains the leading cause of death among Medicare-age adults. Part B addresses this with two distinct cardiovascular benefits:
Cardiovascular Disease Screening
This covers blood tests to check cholesterol, lipid, and triglyceride levels. It's available once every 5 years and is covered at no cost for all Part B enrollees. No specific age cutoff applies — enrollment in Part B is the only eligibility requirement.
Intensive Behavioral Therapy for Cardiovascular Disease
If you have been diagnosed with cardiovascular disease or have risk factors such as hypertension or dyslipidemia, you may qualify for up to 15 individual 15-minute counseling sessions per year focused on diet modification, physical activity, and weight management. These sessions must be delivered in a primary care setting to qualify for $0 cost-sharing.
This benefit is frequently overlooked — partly because it requires a referral from your primary care provider and partly because many beneficiaries don't know it exists. If cardiovascular risk is relevant to you, ask your doctor whether you qualify at your next AWV.
Eligible beneficiaries can receive up to 15 free cardiovascular counseling sessions per year — but most never know to ask.
Diabetes Screenings and Self-Management Training
Part B takes diabetes prevention seriously, offering both screening tests and structured education programs.
Diabetes Screening Tests
If you have any of the following risk factors, you qualify for up to two fasting glucose tests per year at no cost:
- High blood pressure (hypertension)
- History of abnormal cholesterol or triglyceride levels
- Obesity (BMI ≥ 30)
- A history of high blood sugar
You don't need a diabetes diagnosis to qualify — this is specifically a prevention and detection benefit.
Diabetes Self-Management Training (DSMT)
If you have already been diagnosed with diabetes, Part B covers up to 10 hours of initial diabetes self-management training in the first year, and 2 hours of follow-up training each subsequent year. Training covers blood sugar monitoring, medication adherence, nutrition, and foot care — practical skills that meaningfully reduce complication rates.
Medical Nutrition Therapy (MNT)
Beneficiaries with diabetes or kidney disease (non-dialysis) can receive Medical Nutrition Therapy from a registered dietitian — 3 hours in the first year, 2 hours annually thereafter, at $0 cost-sharing. This is a clinical service, not a general wellness perk, and requires a physician referral.
Diabetes self-management training — up to 10 free hours in year one — dramatically reduces complications for newly diagnosed beneficiaries.
Mental Health and Behavioral Health Screenings
Mental health often gets less attention in Medicare conversations, but Part B includes meaningful preventive benefits in this category.
Depression Screening
All Part B enrollees are entitled to one depression screening per year at no cost, administered in a primary care setting. This is a brief questionnaire (often the PHQ-2 or PHQ-9) designed to identify depressive symptoms that may warrant further evaluation or treatment. No prior diagnosis or symptoms are required — this is universal preventive coverage.
Alcohol Misuse Screening and Counseling
Part B covers one alcohol misuse screening per year for all enrollees. If the screening indicates risky drinking patterns, you qualify for up to four brief face-to-face counseling sessions per year at $0 cost-sharing, provided they occur in a primary care setting.
Opioid Treatment Programs
For beneficiaries with opioid use disorder, Part B covers a comprehensive Opioid Treatment Program (OTP) bundle — including counseling, toxicology testing, and medication like buprenorphine. While this crosses from preventive into active treatment, it's worth knowing that coverage exists and that cost-sharing rules differ from standard Part B services.
Annual depression screenings are available to every Part B enrollee at zero cost — no symptoms or diagnosis required.
Vaccines Covered Under Part B
Many people assume vaccines are covered under Medicare Part D (prescription drug plans). For most routine vaccines, that's true. But Part B covers a specific and important set of immunizations directly:
- Flu vaccine (influenza) — one dose per flu season, no cost-sharing
- COVID-19 vaccine — all recommended doses and boosters, no cost-sharing
- Pneumococcal vaccines — two different pneumococcal shots are recommended (PCV15 or PCV20, plus PPSV23 if indicated), both covered at $0
- Hepatitis B vaccine — covered for beneficiaries at medium or high risk (including people with diabetes, kidney disease, or certain other conditions)
These vaccines must be administered by a Medicare-enrolled provider and billed correctly to avoid cost-sharing. In practice, most pharmacies and physician offices handle this billing automatically, but it's always worth confirming before you receive the vaccine that your provider will bill Medicare Part B and not pass the cost to you.
Vaccines not in this list — such as shingles (Shingrix) or Tdap — are covered under Part D, not Part B. If you have a Part D plan, those vaccines should also be available at no cost under the Inflation Reduction Act's vaccine provisions.
Flu, COVID-19, and pneumococcal vaccines are all covered under Part B at zero cost — no copay, no deductible applies.
Bone Density and Osteoporosis Screenings
Osteoporosis is a major driver of fractures and hospitalization among older adults, yet bone density testing remains one of the most underused Part B benefits.
Medicare Part B covers bone mass measurement (bone density test) for beneficiaries who meet any of the following criteria:
- Women who have been determined to be estrogen-deficient and at clinical risk for osteoporosis, based on their medical history and other findings
- Individuals with vertebral abnormalities detected on X-ray
- Individuals receiving or expected to receive glucocorticoid (steroid) therapy for more than 3 months
- Individuals with primary hyperparathyroidism
- Individuals being monitored to assess the response to osteoporosis drug therapy
The test is covered once every 24 months (more frequently if medically necessary) at no cost-sharing. The most common test is a DEXA scan, which takes about 10–15 minutes and involves no injections or preparation.
If you are a woman over 65 — or a younger woman with risk factors — this screening is one of the easiest, fastest, and most consequential preventive tests available to you under Part B.
Bone density scans are covered every two years at no cost — yet they're among the least-used Part B preventive benefits.
Glaucoma Screening
Vision care under original Medicare is famously limited — routine eye exams and eyeglasses are generally not covered. But there is one important exception: glaucoma screening.
Part B covers a glaucoma test once every 12 months for beneficiaries at high risk, specifically:
- Individuals with diabetes
- Individuals with a family history of glaucoma
- African Americans age 50 and older
- Hispanic Americans age 65 and older
The screening must be performed or supervised by an eye doctor (optometrist or ophthalmologist) who is legally authorized to perform the test in your state. There is no cost-sharing when billed correctly as a preventive glaucoma screening.
If you don't fall into one of these high-risk groups, routine glaucoma screening is not covered under original Medicare. However, if you have a Medicare Advantage (Part C) plan, your plan may cover additional vision and eye care services beyond what original Part B provides — it's worth checking your plan's Evidence of Coverage document.
Glaucoma screenings are free under Part B — but only for high-risk groups, including people with diabetes and those with a family history.
Abdominal Aortic Aneurysm Screening
This one is lesser-known but potentially life-saving. Part B covers a one-time screening ultrasound for abdominal aortic aneurysm (AAA) for beneficiaries who meet specific criteria:
- Men ages 65–75 who have smoked at least 100 cigarettes in their lifetime
- Individuals with a family history of AAA (referred by their physician)
An abdominal aortic aneurysm is a bulge in the large blood vessel running through the abdomen. They are often asymptomatic until they rupture — which can be fatal. A single ultrasound can detect an aneurysm early, when treatment is far more effective and less risky.
This screening is covered only once under Part B and must be ordered as part of your Welcome to Medicare visit or within the first 12 months of Part B enrollment. That timing constraint makes it especially important for newly enrolled men who have a smoking history to request this referral early.
The cost? Zero — no deductible, no coinsurance, as long as the provider participates in Medicare and bills the service correctly as a screening ultrasound.
Male smokers ages 65–75 get one free AAA ultrasound under Part B — but only if ordered within the first year of enrollment.
Getting the Most Out of Your Covered Preventive Services
Knowing the list is step one. Actually using it — without accidentally triggering cost-sharing — requires a little strategy.
Ask This Question Before Every Preventive Appointment
Before your visit begins, tell your provider: "I'm here for my Annual Wellness Visit only. If anything comes up that's outside the scope of preventive care, I'd like to schedule a separate appointment for that." This single sentence can protect you from unexpected cost-sharing. Providers are required to honor this request, and most appreciate the clarity.
Keep a Personal Screening Calendar
Each preventive service has its own frequency rule, and Medicare won't automatically remind you when you're due. Create a simple list — either in a notes app or on paper — logging the date and type of each screening. Cross-reference it at every Annual Wellness Visit. Your provider can also print a personalized schedule during the AWV, so ask for one.
Always confirm your provider's Medicare participation status before your appointment. A provider who accepts Medicare assignment agrees to charge only Medicare-approved amounts. If your provider is non-participating or has opted out of Medicare entirely, the $0 cost-sharing guarantee does not apply. You can verify participation status at any time through the Medicare.gov Care Compare tool.
Keep your visits focused. If your Annual Wellness Visit turns into a conversation about a new symptom — say, knee pain or a persistent cough — your doctor may shift from preventive mode into diagnostic mode. That shift can convert a $0 visit into one subject to your Part B deductible ($240 in 2024) and 20% coinsurance. You are not obligated to address new problems on the same visit. It's completely reasonable to schedule a separate appointment for any issues that go beyond prevention.
When Preventive Visits Turn Diagnostic
If your doctor identifies and begins evaluating a new health condition during what was scheduled as a preventive visit, Medicare may apply standard Part B cost-sharing (deductible plus 20% coinsurance) to that portion of the visit. This is called "preventive to diagnostic conversion" and it is legal and common. The safest approach is to keep preventive appointments focused strictly on scheduled screenings and wellness activities, and handle new symptoms at a separate visit.
Medicare Advantage Plans May Cover More
If you are enrolled in a Medicare Advantage (Part C) plan rather than original Medicare, your plan must cover at minimum everything Part B covers — but many plans go further, adding dental, vision, hearing, and additional wellness benefits. Always check your plan's Evidence of Coverage document for a complete list of included preventive services, as benefits vary significantly by plan and region.
Track your screening schedules. Each preventive service has its own frequency rule. A colonoscopy, for instance, is covered once every 10 years for average-risk beneficiaries (once every 2 years if you're at high risk). Mammograms are covered annually. Missing the timing window by even a month doesn't disqualify you — but scheduling too early might mean Part B won't cover it, leaving you with the full cost.
If you want a detailed strategy for squeezing maximum value from Part B's outpatient benefits beyond just prevention, our companion guide on making the most of Part B's preventive and outpatient benefits is a logical next step.
For a side-by-side look at how Medicare's preventive coverage compares to what ACA marketplace plans offer, see preventive care services covered at no cost under commercial health plans. And if you're still sorting out what Medicare will cost you overall, the Medicare cost quick-reference guide gives you 2024 figures for all four parts in one place.
The bottom line: the preventive services in this list are already baked into your Part B coverage. They cost you nothing extra to use, and using them consistently is one of the most effective financial and health decisions you can make as a Medicare beneficiary.
All claims in this article are backed by peer-reviewed research. We follow strict editorial guidelines to ensure accuracy and reliability. Sources available on request from our editorial team.
