Get a Cognitive Screening Through Medicare

Your annual wellness visit is an opportunity to check in with your primary care doctor, to go over your health risks and to make sure you’re doing everything you can to prevent illness. This visit — which isn’t the same as your annual physical — is also a good time to check up on things like your memory and thinking skills.

If you’re age 65 or older, Medicare will generally cover the cost of a cognitive screening as part of your annual wellness visit. Yet many older adults aren’t taking advantage of this free service.

According to a 2020 study in the journal Health Affairs, about half of Medicare patients surveyed said they’d had an annual wellness visit, but fewer than a third had had a structured cognitive screening. This is despite the finding from Alzheimer’s Association surveys that four in five older adults see a benefit in taking these tests.

What is a cognitive screening?

This test you can get at your annual wellness visit is a brief test your doctor uses to look for warning signs of thinking and memory problems. How it’s done depends on your doctor, who may:

• Ask you about any symptoms you’ve had
• Watch the way you interact during the visit
• Ask your family or friends about your cognitive and mental health
• Take a medical history and do a physical exam
• Give you a short written or verbal test, such as the Mini-Cog, Memory Impairment Screen (MIS), or General Practitioner Assessment of Cognition (GPCOG)

The screening won’t tell you that you have dementia — only if you may have warning signs.

“It doesn’t provide a definitive diagnosis, but it’s an important first step to determine if further testing is needed,” says Morgan Daven, vice president of health systems at the Alzheimer’s Association.

What’s covered?

Medicare should cover the cost of cognitive screening once every 12 months as part of your annual wellness visit. As long as you’ve had Medicare Part B for more than a year and your doctor participates in Medicare, you should be able to get this annual screening at no cost to you. Your doctor will generally use the billing codes G0438 and G0439 to get reimbursed for your visit. Check with your doctor or provider for specific details about your situation.

Note that you may have to pay a deductible and coinsurance (a percentage of your visit cost) if your doctor performs other tests during the visit that aren’t covered under your preventive care benefits.

For example, “a blood screening would be a common thing they would do to rule out things like problems with your B12 [levels]. That may be a cause of memory problems that are not related to dementia,” says Mireille Jacobson, associate professor of gerontology at the University of Southern California.

One important note: Medicare won’t pay for an annual physical, which is distinct from a wellness visit and typically includes a physical exam and blood tests. When you schedule your appointment, use the words “annual wellness visit” to reduce the chance that you have to pay anything out of pocket.

How useful is it?

The benefits of cognitive screening are a matter of some debate. The U.S. Preventive Services Task Force (USPSTF) reviewed the available research and concluded there isn’t enough evidence on the costs and benefits to recommend screening for people older than age 65.

But the Alzheimer’s Association says since these screenings are covered by Medicare, they are worth having. A cognitive assessment is one tool that may help rule out medical causes of mental decline, such as depression, and identify any concerns that warrant further investigation. “If there is cognitive decline detected, then the doctor can follow up with advanced testing, and refer you to a specialist if a more definitive diagnosis is needed,” Daven says.

How do I get a cognitive screening?

Alzheimer’s Association surveys have found that people wait for their doctors to bring up cognitive screenings, while doctors wait for their patients to bring it up. As a result, these tests often don’t get done.

“In most cases, all the patient has to do is ask the provider for an evaluation,” Daven says. “The annual wellness visit creates a setting where they can raise those concerns and ask the doctor to assess if there are any issues that need follow-up.”