Medicare Preventive Care Benefits: The Free Services Ohio Retirees Keep Missing

Every year we sit down with folks in Beavercreek who have been on Medicare for five, eight, ten years — and every year at least one of them says some version of the same thing: “Nobody told me that was covered.”

Medicare pays for a long list of preventive services at no cost to you. No deductible, no 20% coinsurance, nothing. But Medicare does not send you a reminder card, and a lot of doctors are too busy to run down the whole list. So these benefits sit there unused while people pay out of pocket for things they could have gotten for free, or worse, skip a screening that would have caught something early.

Here is what is actually on the list, what the rules are, and the one billing quirk that catches people every single year.

What Medicare Means by “Preventive”

Preventive care is anything meant to find a problem before you have symptoms, or to keep the problem from starting. Screenings, shots, and certain counseling visits.

Original Medicare covers most of these under Part B at 100% — meaning the 2026 Part B deductible of $283 does not apply, and neither does your usual 20% coinsurance. That is different from almost everything else Part B touches. If you go in for a knee that hurts, that is diagnostic care and the deductible and coinsurance apply. If you go in for a screening because you turned 65 and it is time, that is preventive and it is covered in full.

The catch is that Medicare has specific rules on how often you can get each service, and who qualifies. Get the timing wrong by a month and the claim can come back as your responsibility.

The Two Visits People Mix Up

The “Welcome to Medicare” visit

You get this one time only, and only within the first 12 months you have Part B. It is a review of your health history, medications, risk factors, and a basic screening — height, weight, blood pressure, vision check. Your doctor also puts together a written plan for the screenings you should get going forward.

If you are new to Medicare, put this on the calendar now. Once that 12-month window closes, it is gone for good.

The Annual Wellness Visit

This is the one you get every year after that, starting 12 months after your Welcome visit (or 12 months after your Part B started, if you skipped the Welcome visit). It is free, and there is no limit on how many years you can use it.

Here is what surprises people: the Annual Wellness Visit is not a physical. Medicare has never covered a routine head-to-toe physical exam. The Wellness Visit is a conversation — your doctor updates your medical history, reviews your prescriptions, checks your cognitive function, screens for depression, and updates your personalized prevention plan.

That distinction matters because a lot of Miami Valley practices schedule these back-to-back with a regular office visit, and that is where the billing gets messy. More on that below.

Cancer Screenings That Cost You Nothing

These are the big ones, and the ones people most often delay:

• Colorectal cancer screening. Colonoscopy every 10 years for average risk, or every 2 years if you are high risk. Stool-based tests (FIT, Cologuard) more frequently. A rule change in recent years fixed the old trap where a screening colonoscopy that found and removed a polyp got re-billed as a diagnostic procedure — a follow-up colonoscopy after a positive stool test is now covered as screening too.
• Mammograms. One baseline between 35 and 39, then one screening mammogram every 12 months starting at 40. No cost.
• Cervical and vaginal cancer screening. Pap test and pelvic exam every 24 months, or every 12 months if you are high risk or of childbearing age with an abnormal Pap in the last 3 years.
• Prostate cancer screening. A PSA blood test once every 12 months starting at 50. The blood test itself is free; the digital rectal exam portion can carry coinsurance.
• Lung cancer screening. A low-dose CT scan once a year if you are 50 to 77, have no signs of lung cancer, smoke now or quit within the last 15 years, and have a 20 pack-year history. This one is badly underused. If you worked around Wright-Patterson or spent decades in a plant and smoked, ask about it.

Heart, Diabetes, and Bone Screenings

Less dramatic, but these are where a lot of quiet problems get caught:

• Cardiovascular blood screening — cholesterol, lipids, triglycerides — once every 5 years, no cost.
• Cardiovascular disease visit once a year with your primary doctor to talk about aspirin, blood pressure, and diet.
• Diabetes screening. Up to two fasting blood glucose tests per year if you have risk factors — high blood pressure, history of high blood sugar, obesity, or family history.
• Bone mass measurement every 24 months if you are at risk for osteoporosis. Women past menopause, anyone on long-term steroids, anyone with a history of fractures.
• Abdominal aortic aneurysm ultrasound — a one-time screening if you have a family history, or if you are a man 65 to 75 who has smoked at least 100 cigarettes in your life. You need a referral from your Welcome to Medicare or Wellness Visit to get it.
• Glaucoma test once a year if you are high risk — diabetes, family history, African American and 50 or older, or Hispanic and 65 or older. Note this one does carry the deductible and 20% coinsurance.

There is also the Medicare Diabetes Prevention Program, a once-per-lifetime structured program of coaching and group sessions if you have prediabetes. It is free, it runs about two years, and hardly anyone in our area seems to know it exists.

Vaccines: What Changed Recently

Part B has always covered flu shots (one per season), pneumococcal shots, COVID-19 vaccines, and hepatitis B shots for people at medium or high risk — all at no cost.

The bigger change came on the Part D side. Vaccines recommended for adults by the CDC advisory committee — shingles and Tdap being the two people ask about most — are now covered with no copay and no deductible under Part D drug plans. The shingles vaccine used to run $200 or more out of pocket. If you have been putting it off because of the price, that reason is gone.

One practical note: because shingles falls under Part D and not Part B, you generally need to get it at a pharmacy that bills your drug plan rather than at your doctor office. Most Kroger, CVS, and Walgreens pharmacies around Dayton handle this without a problem, but it is worth a phone call first.

Counseling Benefits Almost Nobody Uses

These are covered in full and get almost no attention:

• Smoking cessation counseling — up to 8 face-to-face visits in a 12-month period, even if you have no symptoms of tobacco-related illness.
• Obesity behavioral therapy — if your BMI is 30 or higher, you get face-to-face counseling sessions with your primary care provider, weekly for the first month, then every other week.
• Alcohol misuse screening once a year, plus up to 4 brief counseling sessions if the screening indicates a problem.
• Depression screening once a year in a primary care setting.
• Nutrition therapy if you have diabetes or kidney disease, or had a kidney transplant in the last 36 months. Three hours the first year, two hours each year after.

The One Thing That Turns a Free Visit Into a Bill

This is the call we get more than any other. Somebody goes in for their free Annual Wellness Visit, and three weeks later a bill shows up for $80.

Here is what happened. During the wellness visit, they mentioned their shoulder had been bothering them. Or asked the doctor to look at a rash. Or wanted to adjust a blood pressure medication. The moment the appointment moves from “review and plan” to “diagnose and treat,” the practice adds a second billing code for a problem-oriented office visit — and that code is subject to your deductible and coinsurance.

The doctor did nothing wrong. The billing is correct. It is just not what the patient expected.

Two ways to handle it. Either save the aches and questions for a separate appointment, or go in knowing that if you bring up a new problem, part of the visit will be billable. Neither is right or wrong — just do it on purpose instead of by accident.

It also helps to say plainly when you schedule: “I am calling to schedule my Medicare Annual Wellness Visit.” Not “a checkup,” not “a physical.” The words matter to the scheduler.

If You Have Medicare Advantage in the Dayton Area

Medicare Advantage plans are required to cover every preventive service Original Medicare covers, at no cost, as long as you stay in network. That last part is the whole ballgame.

Around here that means checking whether the imaging center, the lab, or the specialist your doctor refers you to is actually in your plan network. Premier Health, Kettering Health, and the independent practices scattered across Greene and Montgomery counties do not all contract with the same plans. A screening that would be free in network can land you a real bill out of network.

Many Advantage plans also add preventive extras Original Medicare does not cover — routine dental cleanings, vision exams, hearing tests, a gym membership through SilverSneakers or a similar program. Those are worth using if you are paying for them in your plan design, and a surprising number of members never activate them.

A Simple Once-a-Year Checklist

Every January, do these four things:

1. Schedule your Annual Wellness Visit. Say those exact words when you call.
2. Bring your full medication list — everything, including vitamins and anything you buy over the counter.
3. Ask your doctor which screenings you are due for this year. They can see the dates in your chart faster than you can figure them out.
4. Check your plan for the year. Drug formularies and provider networks change every January 1, and the screening itself being free does not help if the lab that runs it dropped out of your network.

Four things, maybe twenty minutes of phone calls. It is the highest-return twenty minutes in your whole health care year.

Questions? We are Right Here in Beavercreek

Preventive benefits are the easiest part of Medicare to use and the easiest part to overlook, mostly because nobody hands you the list. If you are not sure what you are due for, whether your plan covers a particular screening, or why a “free” visit generated a bill, we are glad to look at it with you.

Medicare & Retirement Solutions Group works with retirees and pre-retirees all over the Dayton area and the greater Miami Valley. There is no charge for a conversation, and no pressure to change anything. Sometimes the right answer is that your current plan is doing exactly what it should.

Give us a call or reach out through medretiregroup.com to set up a free, no-obligation review. We are local, we answer the phone, and we will give you a straight answer.

This article is for general educational purposes and reflects Medicare rules as of 2026. Coverage details and frequency limits can change, and individual circumstances vary — check with your plan or your provider before scheduling.