Press Release             

Contact: Akiko Takano
Deputy Director of Communications

November 4, 2010

Centers for Medicare & Medicaid Services Finalizes Rule that Eliminates Out-of-Pocket Costs for Preventive Services

-- New Coverage Rule to Take Effect in 2011 --

New York, NY—The Centers for Medicare & Medicaid Services (CMS) released a final rule yesterday that implements portions of the Affordable Care Act (ACA) that provide greater access to Medicare’s coverage of preventive services.

As a result of the new health reform law, beginning on January 1, 2011, people with Original Medicare will no longer have to pay a copay, coinsurance or deductible to receive preventive services that are recommended with a grade A or B by the U.S. Preventive Services Task Force. The law does not require Medicare private health plans (also known as Medicare Advantage plans) to cover these services without cost-sharing, but many plans already do so. 

In addition, the rule implements an annual wellness visit, a new benefit under Medicare, for which Medicare consumers will pay nothing out of pocket. During this yearly visit, doctors can update a patient’s care plan, screen for cognitive impairments and measure height, weight and blood pressure, as well as other needed measurements based on the person’s family and medical history. 

“To have preventive services available at no cost to people with Medicare is not only an improvement to the Medicare program, but also encourages both providers and patients to think about health care in a new way,” said Joe Baker, president of the Medicare Rights Center. “By encouraging people to take steps to prevent illness, the law promotes efficient, higher-quality, patient-centered care.”

Examples of Medicare-covered preventive services that will no longer require people to pay out of pocket include: screening mammographies, tests such as colonoscopies and barium enemas to screen for colorectal cancer, and Pap tests to screen for cervical cancer.

A more detailed list of preventive services that will no longer require out-of-pocket payments is available at

The final rule also addresses payment rates to providers, and includes a cut of approximately 25 percent to Medicare Part B physician payments that are required under the Sustainable Growth Rate (SGR) formula, which was enacted as part of the Balanced Budget Act of 1997. In the past, Congress has taken action to avert such cuts. Congress passed legislation in June to prevent cuts from taking place, but the fix was only short term—a 21 percent cut in rates is due to take place on December 1, 2010, and an additional four percent cut is due to take place on January 1, 2011. Without additional Congressional action, the cuts will have to go into effect.

“Averting deep payment cuts to doctors must be a priority for Congress in the next month,” said Baker. “While temporary fixes provide a short-term band-aid, all interested stakeholders must work together to find a long-term solution to assure Medicare consumers continue to have adequate access to services they need.”  


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Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives.


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