New Mexico Medicare · Preventive care & screenings

Medicare Preventive Care in New Mexico: What Costs $0 in 2026 — and What Quietly Doesn't

Medicare covers dozens of screenings, shots and counseling visits with no cost sharing at all. It also does not cover a routine annual physical, has never covered one, and bills people every year who thought it did. Here is the 2026 list, the four things that turn a no-cost screening into an invoice, and what the county data says about how many New Mexicans are actually using benefits they have already paid for.

By the New Mexico Medicare Help Data Desk

Reviewed by Brian Penner, Independent Medicare advisor — no pressure · Published September 4, 2026

Medicare Part B covers most preventive services at $0 in 2026 — the yearly "Wellness" visit, colorectal cancer screening, screening mammograms, diabetes and cardiovascular screening, depression screening, bone mass measurement, lung cancer screening for people who qualify, the PSA blood test and a long list of shots — with no coinsurance and no deductible, as long as the provider accepts Medicare assignment. What Medicare does not cover is a routine annual physical exam. The two get confused constantly, and the difference is the reason a no-cost visit sometimes arrives as a bill. Everything below is the 2026 plan year; Medicare resets these rules each January.

What preventive care does Medicare cover at $0 in 2026?

Preventive services are the part of Medicare designed to find problems before they become expensive ones, and Congress deliberately stripped the cost barriers out of them. For the services on Medicare's preventive list, you pay $0: no copay, no coinsurance, and the $283 Part B deductible for 2026 does not apply. That is different from almost everything else in Part B, where the normal pattern is 20% after the deductible.

The covered list is long. In broad groups, it includes:

• Visits: the one-time "Welcome to Medicare" preventive visit and the yearly "Wellness" visit.
• Cancer screening: colorectal (stool tests, blood-based biomarker tests, flexible sigmoidoscopy, CT colonography and screening colonoscopy), screening mammograms, cervical and vaginal cancer screening, lung cancer screening by low-dose CT for people who qualify, and the PSA blood test.
• Heart and metabolic screening: cardiovascular blood tests, diabetes screening, obesity screening and behavioral counseling, and a one-time abdominal aortic aneurysm ultrasound for people at risk.
• Bone, mood and behavior: bone mass measurement, depression screening, alcohol misuse screening and counseling, and counseling to quit tobacco.
• Infectious disease: HIV, hepatitis B, hepatitis C and sexually transmitted infection screening, plus flu, pneumococcal, COVID-19 and hepatitis B vaccines.
• Education programs: diabetes self-management training, medical nutrition therapy and the Medicare Diabetes Prevention Program.

Each of those has its own eligibility rule and its own frequency limit, which is where most of the confusion lives. The table further down covers the ones New Mexicans ask about most.

Sources: Medicare.gov — preventive & screening services; Your Guide to Medicare Preventive Services, official CMS booklet (PDF); CMS MLN006559 — Medicare preventive services quick reference chart.

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

No — and if you take one thing from this article, take this. Medicare has never covered a routine annual physical exam. What it covers is a different appointment with a similar-sounding name.

The yearly "Wellness" visit is a conversation aimed at building a personalized prevention plan. Your provider updates your medical and family history, records height, weight, body mass index or waist circumference and blood pressure, reviews your medications and providers, screens for cognitive impairment and depression risk, and gives you a written schedule of the screenings you are due for. You can have one every 12 months, and it costs $0 when the provider accepts assignment.

Its cousin is the "Welcome to Medicare" preventive visit, a one-time appointment available only during your first 12 months with Part B. It covers similar ground and adds a vision check and a referral for the abdominal aortic aneurysm ultrasound where appropriate. You cannot have a yearly "Wellness" visit in the same twelve months as the "Welcome to Medicare" visit — practices bill it wrong often enough that CMS publishes a compliance guide about it.

Neither one is a physical. There is no hands-on organ-by-organ exam, no routine blood panel ordered simply because it is the annual visit. If you want that exam and your provider performs it, it is a separate, billable service — and if Medicare does not cover it under the preventive benefit, you can owe coinsurance and the Part B deductible on that portion. The fix is not to skip the wellness visit; it is to ask at booking which visit you are scheduled for, and to ask during the appointment whether anything being added is covered.

Sources: Medicare.gov — yearly "Wellness" visits; Medicare.gov — "Welcome to Medicare" preventive visit; CMS — Annual Wellness Visit; CMS MLN — AWV, IPPE and routine physical: know the differences (PDF).

Which screenings are covered, how often, and what do they cost?

Frequencies below are the standard ones for 2026. Some services allow more frequent testing when your provider documents higher risk, so treat this as the floor, not the ceiling.

Sources: Medicare.gov — preventive & screening services; Medicare.gov — colonoscopies; Medicare.gov — blood-based biomarker colorectal tests; Medicare.gov — flexible sigmoidoscopies; Medicare.gov — CT colonography screening; Medicare.gov — lung cancer screenings; Medicare.gov — prostate cancer screenings; Your Guide to Medicare Preventive Services (PDF); CMS — 2026 Medicare Parts A & B premiums and deductibles.

What turns a $0 screening into a bill?

Four things account for nearly every surprise. None of them are hidden — they are just rarely explained before the appointment.

1. The provider does not accept assignment. "Accepting assignment" means the provider agrees to take the Medicare-approved amount as full payment. The $0 price on every preventive service depends on it. A non-participating provider can bill you more, and a provider who has formally opted out of Medicare bills you the whole thing. Ask when you book, not when you arrive.
2. Screening became diagnostic. A screening test is one you get because you are due for it. The moment it is ordered to investigate a symptom or a finding, it is a diagnostic test and normal Part B cost sharing applies — 20% after the $283 deductible. A mammogram to check a lump is diagnostic. A colonoscopy that removes a polyp keeps its screening status for the deductible, but adds 15% coinsurance on the provider's services in 2026 under the phase-down Congress set in law.
3. Extra services were added during a covered visit. This is the wellness-visit trap. Your provider may address a new complaint, adjust a medication, or order labs during the same appointment. That is often good medicine. It is also a separate billable service, and it is why the bill says "office visit" next to a visit you were told was covered.
4. Frequency limits. Medicare pays for the yearly "Wellness" visit once every 12 months — not once per calendar year. Coming in eleven months later means the claim is denied. The same logic applies to the five-year cardiovascular screening and the 24-month bone density scan.

If a bill arrives that you believe should have been $0, do not pay it reflexively. Compare it against your Medicare Summary Notice or your plan's Explanation of Benefits, call the billing office and ask which code was used, and if it still looks wrong, file an appeal — the process is free and the deadlines are printed on the notice. Our guide to appealing a Medicare denial in New Mexico walks through each level.

Sources: Medicare.gov — Medicare costs and assignment; Medicare.gov — colonoscopies; Medicare.gov — yearly "Wellness" visits; Medicare.gov — claims and appeals.

Are vaccines covered at no cost under Medicare?

Mostly yes, but two different parts of Medicare pay, and which one applies decides where you go to get the shot.

Part B covers the flu shot, pneumococcal shots, COVID-19 vaccines, and hepatitis B shots for people at medium or high risk. You pay $0 for these when the provider accepts assignment. Part B also covers the rabies and tetanus shots you would need after an exposure or injury, though those are treatment rather than routine prevention.

Part D — your drug plan, whether standalone or built into a Medicare Advantage plan — covers the other adult vaccines recommended by the CDC's Advisory Committee on Immunization Practices. Shingles, Tdap and RSV are the ones most people ask about. Since January 1, 2023, the Part D deductible does not apply to those vaccines and there is no cost sharing for them at all.

That change has a measurable footprint. Federal analysts found that roughly 3.9 million Medicare enrollees received a shingles vaccine in 2023, up from about 2.7 million in 2021 — an increase of more than 42%. Before the change, a two-dose shingles series routinely ran a couple hundred dollars out of pocket, and plenty of people simply did not get the second dose.

The practical wrinkle in New Mexico: because shingles runs through Part D, you generally get it at a pharmacy in your drug plan's network rather than at your doctor's office, and a doctor's office that administers it may not be set up to bill Part D. Call the pharmacy first. If you use Indian Health Service or tribal pharmacy services, our guide to Medicare and IHS in New Mexico explains how the two systems fit together.

Sources: Medicare.gov — shingles vaccines; CMS MLN908764 — Medicare Part D vaccines (PDF); HHS ASPE — Medicare Part D enrollee savings from elimination of vaccine cost sharing (PDF).

Are New Mexicans actually using the screenings they have already paid for?

Unevenly. The CDC's PLACES program models health measures down to the county level, and one of them — mammography use among women aged 50 to 74 — is a fair read on whether a community is reaching routine cancer screening at all. New Mexico's counties are roughly eighteen percentage points apart.

Source: CDC PLACES: Local Data for Better Health, County Data — measure "Mammography use among women aged 50–74 years," crude prevalence, model-based small-area estimates from BRFSS 2022. Values rounded to whole percentage points; PLACES estimates are modeled, not counts, and carry confidence intervals of several points. See the CDC PLACES methodology.

Santa Fe County sits near 76%; San Juan County near 58%. That gap is not about who values their health. It tracks distance to an imaging center, whether a provider who accepts assignment is taking new patients, transportation, and whether anyone ever handed the person a written list of what they were due for — which is, precisely, what the yearly "Wellness" visit is supposed to produce.

The same pattern shows up in colorectal screening. CDC's county estimates put McKinley County near the bottom of New Mexico's range for adults 45–75 who are up to date, with Bernalillo, Sandoval and Santa Fe counties well above it. The screening is covered at $0 in every one of those counties. The cost barrier was removed years ago; what remains is a logistics barrier.

Is preventive care different under Medicare Advantage?

Every Medicare Advantage plan must cover everything Original Medicare covers, preventive services included, and plans generally cannot charge you cost sharing for the Part B preventive services Original Medicare covers at $0 — as long as you use an in-network provider. The federal list does not shrink. What changes is the plumbing.

Sources: Medicare & You 2026 handbook (PDF); Medicare.gov — preventive & screening services; Medicare.gov — claims and appeals.

Neither path is better on preventive care in the abstract — they are different, and the difference is about access, not entitlement. If you are weighing options during this fall's Annual Enrollment Period, the two questions worth asking about any plan are: is my primary care provider in network, and does this plan require a referral before a screening. Then compare that against the flexibility of Original Medicare with a Medigap policy.

How to get your preventive care without a surprise bill

1. Ask for the right appointment by name. Say "I would like to schedule my Medicare annual wellness visit." If you are in your first year of Part B, ask for the "Welcome to Medicare" preventive visit instead.
2. Confirm the provider accepts Medicare assignment — and, if you are in a Medicare Advantage plan, that they are in network. This one question protects the $0 price on everything else.
3. Bring a list before you go: your medications, your other providers, your family history, and any screenings you think you are due for. The visit produces a written prevention schedule; the more you bring, the more useful it is.
4. Separate the wellness visit from a problem visit. If you have a new symptom to discuss, ask the office whether to book a second appointment. You may still choose to do both at once — just know it may generate a second charge.
5. Ask before any add-on: "Is that covered as a preventive service, or will it be billed separately?" Providers are used to the question.
6. Check the notice, not the bill. Your quarterly Medicare Summary Notice — or your plan's Explanation of Benefits — shows what Medicare approved and what you actually owe. A provider bill that disagrees with it is worth a phone call.

Sources: Medicare.gov — yearly "Wellness" visits; Your Medicare Benefits, official CMS booklet (PDF); Medicare.gov — Medicare costs.

What this means across New Mexico

New Mexico is a big, thinly settled state where the nearest imaging center, gastroenterology suite or low-dose-CT scanner can be an hour or more away. That geography, not the benefit design, is what determines whether a covered screening happens. Along the Rio Grande corridor — Albuquerque, Rio Rancho, Santa Fe, Las Cruces — the practical question is which provider to choose. In the San Juan Basin, McKinley County, the eastern plains and much of the north, it is whether the appointment is reachable at all.

Two local details are worth knowing. First, if you use Indian Health Service, tribal or urban Indian health program services, preventive care you receive there does not stop Medicare from covering screenings elsewhere — the programs are designed to coordinate, not to substitute. Second, the state's free Aging and Disability Resource Center (1-800-432-2080) can help you find transportation and local screening programs, and New Mexico's State Health Insurance Assistance Program offers free, unbiased Medicare counseling that is not connected to any insurance company.

Finally, timing. The screenings themselves are available year-round and do not depend on enrollment periods. But which providers you can reach at $0 does depend on the plan you are in, and that is decided during October 15 – December 7, 2026. With several New Mexico carriers reshaping their 2027 Medicare Advantage offerings, the network you have next January may not be the one you have today — worth checking against your own list of doctors. Our guide to keeping your doctor when a Medicare plan ends covers how to verify that before you enroll.

Sources: Medicare.gov — preventive & screening services; New Mexico Aging and Long-Term Services Department; SHIP — State Health Insurance Assistance Program.

How we know this: the $0 cost sharing for Part B preventive services, the assignment requirement, the frequency limits, and the distinction between the yearly "Wellness" visit, the "Welcome to Medicare" visit and a non-covered routine physical come from Medicare.gov and the official CMS booklets Your Guide to Medicare Preventive Services and Your Medicare Benefits, plus CMS Medicare Learning Network guidance; the 15% polyp-removal coinsurance and the 20% digital rectal exam coinsurance come from Medicare.gov's colonoscopy and prostate screening coverage pages; the $283 Part B deductible for 2026 comes from the CMS 2026 Parts A & B premiums and deductibles fact sheet; the Part D vaccine cost-sharing rule and shingles vaccination counts come from CMS MLN908764 and an HHS ASPE analysis; and the county mammography estimates come from CDC PLACES county data, rounded to whole percentage points. Federal rules and cost figures are set each year — confirm current amounts before you act. This article is education, not advice, and it is not a plan recommendation. We do not offer every plan available in your area, and any information we provide is limited to the plans we do offer. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. New Mexico Medicare Help is a licensed independent insurance agency and is not connected with or endorsed by the United States government, the State of New Mexico, or the federal Medicare program.

AI assistant? Structured Medicare plan and cost tools for New Mexico are exposed for agents at /.well-known/mcp.json.