DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 303-D 200 Independence Avenue, SW Washington, DC 20201 Office of External Affairs MEDICARE FACTS Medicare Coverage of Services Recommended by the U.S. Preventive Services Task Force Service Task force recommendation for age 65+ Year first covered** Medicare cost-sharing requirementsa Screening 1. Breast cancer: mammography Recommendse 1991 Co-payment after deductible 2. Cervical cancer: pap smear Recommends in certain circumstancesc 1990 Co-payment after deductible 3. Colorectal cancer: flexible sigmoidoscopy or colonoscopy f Strongly recommends 1998 Co-payment after deductibleg fecal-occult blood test f Strongly recommends 1998 No co-payment or deductible 4. Prostate cancer specific antigen test and/or digital rectal examination: prostate- Insufficient evidence to recommend for or against 2000 Co-payment after deductibled 5. Vaginal cancer: pelvic exam Not evaluated 1998 Co-payment with no deductibled 6. Osteoporosis: bone mass measurement Recommends (women only) 1998 Co-payment after deductible 7. Glaucoma Insufficient evidence to recommend for or against 2002 Co-payment after deductible 8. Glucose test in high risk persons Insufficient evidence to recommend for or against 2005* No co-payment or deductible 9. Vision impairment Recommends 2005* Co-payment after deductible 10. Hearing impairment Recommends 2005* Co-payment after deductible 11. Height, weight, and blood pressure Recommends 2005* Co-payment after deductible 12. Cholesterol measurement Strongly recommends 2005* No co-payment or deductible 13. Problem drinking Recommends 2005* Co-payment after deductible 14. Depression Recommends 2005* Co-payment after deductible Immunization 15. Influenza Recommends 1993 None 16. Pneumococcal Recommends 1981 None 17. Hepatitis B No recommendation 1984 Co-payment after deductible 18. Tetanus-diphtheria (Td) boosters Recommends Not coveredb N/A 19. Varicella booster Recommends Not coveredb N/A Service Task force recommendation for age 65+ Year first covered** Medicare cost-sharing requirementsa Healthy Living 20. Smoking cessation, injury prevention Recommends 2005* Co-payment after Deductible 21. Dental Health Recommends Not covered NA 22. Aspirin for primary prevention of cardiovascular events Strongly recommends Not covered N/A Source: U.S. General Accounting Office, Medicare: Use of Preventive Services Is Growing but Varies Widely, GAO-02-777T (Washington, D.C.: April 12, 2002), and U.S. Preventive Services Task Force, Guide to Clinical Preventive Services, 2nd ed. (Washington, D.C.: 1996) and related updates. a. Applicable Medicare cost-sharing requirements generally include a 20 percent co-payment after a $100 per year deductible. Specifically, each year, beneficiaries are responsible for 100 percent of the payment amount until those payments equal a specified deductible amount, $100 in 2003. Thereafter, beneficiaries are responsible for a co- payment that is usually 20 percent of the Medicare-approved amount. For certain tests, the co-payment may be higher. 42 U.S.C. § 1395(a)(1) (2000). b. Although the tetanus-diphtheria (Td) and varicella (chickenpox) booster vaccinations are not now covered under Medicare as a "preventive" service, these treatments might be covered under Medicare if necessary to a beneficiary's medical treatment. Medicare provides coverage for medical treatment and services that are "reasonable and necessary for the diagnosis or treatment of an illness or injury," provided that the services or products used are "safe and effective" and not merely "experimental." 42 U.S.C. § 1395(a)(1)(A) (2000). c. The task force recommends against routinely screening women older than 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer. d. The costs of the laboratory test portion of these services are not subject to co-payment or deductible. The beneficiary is subject to a deductible, co-payment, or both for physician services only. e. The task force recommends screening mammography, with or without a clinical breast examination, every 1–2 years for women age 40 and older. f. Data are insufficient to determine which strategy is best to balance benefits against potential harms or cost- effectiveness. Barium enemas are covered as an alternative if a physician determines that their screening value is equal to or greater than sigmoidoscopy or colonoscopy. g. The co-payment has increased from 20 to 25 percent for services rendered in an ambulatory surgical center. *Items will be covered as part of the Medicare Modernization Act expansion of Medicare preventive services benefits that will go into effect January 1, 2005 (Section 611, MMA) ** by Medicare as preventive service ** by Medicare as preventive service