An important part of keeping you healthy at any age is routine annual examinations and preventive screening tests. Many preventive services are covered under both Medicare and the Service Benefit Plan when you use a Preferred network provider.
This chart provides a summary of preventive services covered by both Medicare and the Service Benefit Plan. Refer to Medicare's publication Medicare Preventive Services (CMS PUB No. 10110) and the 2007 Blue Cross and Blue Shield Service Benefit Plan brochure for more information.
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Covered
Service
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Medicare
Coverage
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What You Pay With
The Service Benefit
Plan When You Use
A Preferred Network
Provider |
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Routine Physicals
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One "Welcome to Medicare" exam within the first six months of enrollment
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When Medicare Part B is the primary payer, nothing for annual physicals.
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Vaccines/
Immunizations
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Pneumonia - Benefits are available, but check with your physician. Some individuals only need one immunization in their lifetime.
Influenza (Flu) - Benefits are paid for one per year in the fall or winter.
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When Medicare Part B is primary:
Pneumonia - Nothing for one every flu season.
Influenza - Nothing for one every calendar year.
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Screening Mammograms
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Benefits are available for mammograms for women age 40 and older every 12 months.
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When Medicare Part B is primary, nothing.
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Pap Smears and Pelvic Examinations
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Benefits are available for these services once every 24 months or once every 12 months if you are in a high-risk group for cervical and vaginal cancer.
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When Medicare Part B is primary, nothing for Pap smears and the associated office visit.
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Colorectal Screenings
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Benefits are available for the following for individuals age 50 and older:
Fecal Occult Blood test - Benefits are paid for one test every 12 months.
Flexible Sigmoidoscopy - Benefits are paid for one test every 48 months.
Colonoscopy - Benefits are paid for one test every 24 months if you are a high risk for colon cancer. There is no age minimum.
Barium Enema - Benefits are paid for one every 24 months if you are at high risk for colon cancer and for one every 48 months if you are not.
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When Medicare Part B is primary, the following services are covered:
Fecal Occult Blood test -Nothing.
Sigmoidoscopy - Nothing.
Colonoscopy - Nothing.
Barium Enema - Nothing.
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Prostate Cancer Screening
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Benefits are available for men age 50 and older:
Benefits are provided for one Prostate Specific Antigen (PSA) and digital rectal examination test every 12 months.
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When Medicare Part B is primary, nothing.
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Bone Mass (Density) Tests
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Benefits are paid for individuals at risk for osteoporosis once every 24 months.
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When Medicare Part B is primary, nothing.
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