The free list

The Medicare services that are genuinely free, and the trap that bills you anyway

Short answer: Medicare covers a long list of preventive services at no cost to you, no deductible and no coinsurance, provided your doctor accepts assignment and the visit is coded as screening. That list includes the yearly wellness visit, mammograms, colonoscopies, cardiovascular and diabetes screenings, bone density tests, lung cancer scans, depression screening, and every recommended vaccine. The trap is in that last clause: the moment a screening becomes diagnostic, normal cost sharing applies, which is how people get bills for something they were told was free.

By the Medicare Decoder team · Updated September 30, 2026 · 4-minute read · Figures are official CMS amounts, checked against CMS

Key takeaways

Most preventive screenings and all recommended vaccines cost $0 when your provider accepts assignment.
The yearly wellness visit is free, but it is not a physical exam, and asking about a new symptom can turn it into a billable visit.
Screening becomes diagnostic when a problem is found or investigated, and diagnostic services carry the usual 20% coinsurance.
Colonoscopy coinsurance for polyp removal during a screening is being phased out, reaching $0 later this decade.
Preventive services are covered by Medicare Advantage plans too, at no cost when using in-network providers.

Jump to What is free The wellness visit confusion Screening versus diagnostic Getting the benefit FAQ

What is actually free

Category	Examples	Frequency
Visits	Welcome to Medicare visit; yearly wellness visit	Once in the first year; annually thereafter
Cancer screening	Mammograms, cervical and vaginal screening, colorectal screening, lung cancer scans, prostate PSA	Varies by test and risk
Heart and metabolic	Cardiovascular disease screening, cholesterol, diabetes screening, obesity counseling	Typically annually or as indicated
Vaccines	Flu, pneumococcal, COVID-19, hepatitis B, shingles and all others recommended by ACIP	As recommended
Other screening	Bone density, abdominal aortic aneurysm ultrasound, depression, alcohol misuse, HIV and STI screening, hepatitis C	Varies
Counseling	Smoking cessation, nutrition therapy for diabetes or kidney disease, behavioral counseling	Varies

Free means no deductible and no coinsurance when the provider accepts assignment and the service is billed as preventive. Frequency limits apply to most screenings.

Vaccines deserve a note because the rules improved recently and many people missed it: all vaccines recommended by the federal advisory committee, including shingles, now cost $0 under Part D, where they used to carry real cost sharing. The vaccine article covers which part pays for what and why your pharmacy, rather than your doctor’s office, is often the right place to get them.

The wellness visit confusion

The annual wellness visit is free, and it is not a physical examination. It is a prevention planning appointment: a health risk assessment, a review of medications and history, cognitive screening, and a written prevention schedule. Medicare does not cover routine annual physicals as such. This is why people leave a "free" visit with a bill: they raised a new symptom, the doctor evaluated and treated it, and that portion was billed as a problem visit with normal 20% coinsurance. That is not a scam, it is the coding, and you can steer it by asking at the start which parts of the visit are preventive and whether anything you raise will be billed separately. The full explanation covers what the visit includes and how to prepare.

Screening versus diagnostic

The same test can be free or not depending on why it was ordered. A mammogram ordered as routine screening is $0; a mammogram ordered to investigate a lump is diagnostic and carries the usual coinsurance. A screening colonoscopy is $0; a colonoscopy done because of symptoms is diagnostic. One special case worth knowing: when a polyp is removed during a screening colonoscopy, the procedure historically became diagnostic and triggered coinsurance. That cost sharing is being phased out in stages and reaches $0 later this decade, so the amount you owe depends on the year the procedure happens. If you receive an unexpected bill after a screening, ask the office how it was coded before assuming it is correct, because coding errors happen and are fixable.

Getting the benefit

Confirm your provider accepts assignment. The $0 price depends on it, exactly as described in the assignment article.
Book the wellness visit deliberately, and use the phrase "annual wellness visit" when scheduling so the office codes it correctly.
Separate concerns from screening. If you have a new problem to discuss, consider a separate appointment, or accept that it will be billed and know that in advance.
Track frequency limits. Screenings have intervals, and getting one early can make it billable. Your Medicare account shows what you have used and when you are eligible again.
On Medicare Advantage, the same preventive services are covered at no cost, but generally only in network, which is one more reason to verify providers as the checklist describes.

Questions people also ask

What preventive services are free with Medicare?

Most screenings and all recommended vaccines, including the yearly wellness visit, mammograms, colorectal and lung cancer screening, cardiovascular and diabetes screening, bone density tests, depression screening, and smoking cessation counseling, with no deductible or coinsurance when your provider accepts assignment.

Is the Medicare annual wellness visit the same as a physical?

No. The wellness visit is a prevention planning appointment covering a health risk assessment, medication review, cognitive screening, and a personalized prevention schedule. Medicare does not cover routine annual physicals, and discussing a new medical problem during the visit can generate a separate billable charge.

Why did I get a bill for a free Medicare screening?

Usually because the service was coded as diagnostic rather than screening, because something was found or investigated, or because the provider does not accept assignment. Ask the office how the visit was coded; coding errors happen and can be corrected.

Does Medicare cover colonoscopy for free?

A screening colonoscopy is covered at no cost. If a polyp is removed during the screening, coinsurance historically applied, and that cost sharing is being phased out in stages toward $0 later this decade, so what you owe depends on the year of the procedure.

Are vaccines free on Medicare?

Yes. All vaccines recommended by the federal advisory committee, including shingles, are available at no cost, with most covered under Part D through a pharmacy and some, such as flu and pneumococcal, covered under Part B.

Sources for this article

Medicare.govPreventive and screening services: the covered list, frequency limits, and cost sharing.
Medicare.govMedicare coverage: how screening and diagnostic services are treated differently.
Medicare.govMedicare.gov: assignment, provider participation, and your coverage record.

Figures checked against these sources on September 30, 2026. We update within days when CMS publishes new amounts.

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