OBJECTIVES: The Secretary of the Department of Health and Human Services is empowered by law to base Medicare reimbursement on the United States Preventive Services Task Force (USPSTF) recommendations (Grade A, benefits certainty high; B, benefits certainty moderate; and D, recommends against service). The purpose of this study was to evaluate the congruence between the USPSTF recommendations and their respective Medicare coverage policies. METHODS: , The USPSTF website and Medicare preventive services guide were reviewed through December 2012 to study alignment between the USPSTF recommendations and Medicare coverage policies. Two reviewers independently extracted the data. We excluded USPSTF recommendations that were: I or C grade, inactive, for injury/violence, only valid for people <65 years, for preventive medication, or update-in-progress. Included USPSTF recommendations were categorized by therapeutic area (e.g., cancer), sub-therapeutic area (e.g., breast cancer), and recommendation class (i.e., screening and counselling). More than one recommendation for same sub-therapeutic area was treated separately. RESULTS: A total of 128 USPSTF recommendations were found, of which 37 (28.90%) were included in the analysis. The largest percentage of recommendations were for cancer (29.72%, n=11), followed by infectious diseases (27.02%, n=10).  The vast majority were for screening (91.89%, n=34). Most of the Grade A and B USPSTF recommendations (94.11%, n=16) were covered by Medicare. However among USPSTF grade D recommendations, 35% (n=7) were also covered by Medicare (e.g., prostate-specific antigen based prostate cancer screening). As per the healthcare reform’s objective of investment in prevention and illness, all of the included USPSTF recommendations were covered by Medicare without out-of-pocket payment, except one (i.e., tobacco cessation counselling). CONCLUSIONS: Medicare coverage policies for preventive services should be re-examined, especially those for which the USPSTF has issued grade D recommendations. Continuing such grade D recommendations without any established benefits will likely lead to unnecessary healthcare services and costs.