The Medicare program can be very confusing, even when it comes to seemingly basic questions like “What does Medicare cover?”
What Is Medicare?
Medicare is basically a government run health care insurance program. Those in the US who are 65 and older are eligible for coverage. Though some younger than 65 with disabilities may qualify.
What Does Medicare Cover?
Medicare covers a wide range of medical and health related products, services and treatments. What exactly is covered depends on a few key factors. They are:
- What kind of Medicare coverage you have
- Where you live
- The reason you need the product, service and/or treatment
Let’s dig a little deeper into each of these factors below.
What Kind of Medicare Coverage You Have
There are a number of different types or parts of Medicare coverage. You may have heard about Part A, Part B, etc. when it comes to Medicare. Each one of those covers different things. Here is an overview of what each part covers.
Inpatient Hospital Care
This covers inpatient care at long-term hospitals, inpatient mental health hospitals, critical access hospitals and acute care hospitals.
In these settings, Medicare Part A will typically cover: a semi-private room, meals, general nursing care, physical therapy, occupational therapy, prescription drugs/medical supplies, specialty unit care (ie. Intensive care) , lab/imaging tests and operating room services.
Skilled Nursing Home Facility Care
If a stay at a skilled nursing facility is required, Medicare Part A generally covers: a semi-private room, meals, skilled nursing care, prescription drugs/medical supplies, ambulance transport (if medically required).
Nursing Home Care
Medicare Part A may cover nursing home care for a limited time if skilled nursing care is required. The usual coverage includes: a semi-private room, meals, general nursing care, physical therapy, occupational therapy, and prescription drugs/medical supplies
Part A also covers hospice care for those with a terminal illness with less than 6 months to live. The specific things covered for hospice include: care to manage symptoms/control pain for those with terminal illness, prescription drugs/medical supplies, general nursing care, and doctor services.
Home Health Care
Home health care coverage is limited to those who have been discharged from an inpatient hospital stay but still require care during recovery. In this situation, Medicare Part A typically covers: physical therapy, occupational therapy, skilled healthcare, and prescription drugs/medical supplies.
Next we’ll look at what Medicare Part B covers. Broadly, Part B covers medically necessary services like outpatient care as well as preventative services.
The list below is a partial list of what Part B covers. For a complete, updated list of what’s covered visit the official Medicare website.
- Doctor visits
- Some prescription drug coverage
- Vaccines including flu, tetanus, Hepatitis B and pneumonia shots
- Emergency Department services
- Home health services
- Physical therapy / Occupational therapy
- Ambulance services
- Chiropractic treatment
- Mental health services
- Some medical equipment like walkers and hospital beds
- Outpatient Medical & Surgical Services
- Smoking Cessation
- Some lab tests
- Annual wellness visit with your primary care provider
- Some cancer screenings
- Diabetes screening, supplies and services and, if you qualify, prevention program
- Depression screenings
- Alcohol abuse screenings and counseling
Medicare Part C is offered by private health insurance companies. It’s also known as Medicare Advantage. It covers what Parts A & B do but can also offers some extra services and benefits the other Parts don’t.
In addition to what Part A & B cover, Part C may cover:
- Prescription drugs you take at home
- Dental care including routine cleanings, x-rays and dentures
- Vision care that may include contacts and eyeglasses
- Hearing care that may include hearing aids
- It may also provide gym memberships and meal delivery services
Lastly we come to Medicare Part D. Part D is basically prescription drug coverage. It is offered by private insurance companies. This means the specific drugs covered will differ from plan to plan (though the government does have minimum coverage requirements). Which drugs are covered also depends on what tier of coverage you get.
Also important to know is, no matter what plan you have, Medicare Part D only covers FDA approved prescription drugs.
Where You Live
Your Medicare coverage and what Medicare will pay for can depend on where you live. Your “Original” Medicare coverage – Parts A and B – are national plans. The basic coverage they provide is standard across the United States.
However, that’s not the case with Medicare Advantage plans and Prescription Drug plans offered by private insurance. Coverage for these plans, their costs, what they cover, etc. may vary depending on what state you live in.
Your Reason for Needing a Treatment, Product or Medical Service
What Medicare will cover also depends on why you need a specific treatment, product or medical service.
Let’s take shoe inserts for example. Medicare won’t cover shoe inserts for just anyone. But it will if you need them due to diabetes and severe diabetic foot disease.
Consult with your medical provider to see if their recommended treatment, etc. is covered for someone who has your condition, disease or illness.
A Look At Common Treatments, Medical Services and More That Medicare Covers
People have questions about Medicare coverage for all sorts of specific treatments, services and more. Below you’ll find an ever-growing list of them that you can click on to find out whether Medicare will pay for them. You’ll also find info on costs and pricing as well as some helpful background info about each. We hope you find this useful!