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Frequently Asked Questions

When you receive preventive care, you won't have a copay. During that visit, if you also receive care that's not considered preventive care, then a copay will be charged. For example: If you go to your doctor for a seasonal flu shot and an annual wellness visit, you wouldn't have a copay because these are preventive care services. If during the same visit, you tell your doctor about a condition that requires an X-ray or you ask to have a skin tag removed, you would have a copay for those two services. That's because the X-ray is used to diagnose and the skin tag removal is a separate procedure, neither of which are considered preventive care.

It's helpful to know what types of care are considered preventive.

Preventive care includes:

  • An annual wellness visit that is a comprehensive, preventive medicine evaluation that results in a prevention plan based on your needs
  • Services to help you avoid illness or injury, including flu shots or pneumonia vaccines
  • Tests and screenings to detect undiagnosed diseases or problems, including routine cancer screenings, such as mammograms

Preventive care does not include:

  • Diagnosis or monitoring of a problem or symptom you already have
  • Treatment of pain or other symptoms of an illness or disease
  • Treatment of problems found during a preventive care appointment

Before going to a skilled nursing facility, Medicare requires that you stay in the hospital as an inpatient for three consecutive days. Sometimes when you go to the hospital, the hospital will put you on observation status before admitting you.

This observation period doesn't count toward the three-day stay that Medicare requires. Without a three-day inpatient stay, Medicare won't cover your skilled care charges.

If you do meet the three-day stay requirement, your skilled nursing facility charges are covered for up to 100 days each benefit period.

About Skilled Nursing Facility billing on Medicare.gov




Last Updated: December 2020

Date: 1/19/2021 9:41:05 AM Version: 4.0.30319.42000 Machine Name: PWIM4-CDWEB01