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What Does Original Medicare Cover?

Medicare Part A and Medicare Part B each provide coverage for different types of services. If you require a specific health test or medical procedure, but are unsure which part of Medicare will cover it, this comprehensive list can help.

Does Original Medicare Cover…

Abdominal aortic aneurysm screening?

Yes, Medicare Part B does cover it one time, but you must have a referral from your doctor.

Acupuncture?

No.

Advance care planning?

Yes, Medicare Part B covers it as a part of your Yearly “Wellness” visit. This allows you to plan ahead for care you desire in the event that you are unable to speak for yourself.

Air-fluidized beds and other support surfaces?

Yes, under Medicare Part B.

Alcohol misuse screening and counseling?
Yes, you can be screened once a year under Medicare Part B. If your doctor finds that you have an alcohol dependency, you can get four face-to-face counseling sessions per year.

Ambulances?

Yes. Medicare Part B covers ambulance services, but only when other transportation could endanger your health. Medicare pays for transportation to the closest facility that is able to provide the necessary care.

Ambulatory surgical centers?
Yes, under Medicare Part B.

Anesthesia?

Yes, under both Medicare Part A and Part B, depending on where you are receiving the anesthesia. Part A would cover it in an inpatient hospital setting, while Part B would cover if in an outpatient setting or ambulatory surgical center.

Artificial eyes and limbs?

Yes. Medicare Part B covers them when ordered by a doctor who accepts Medicare.

Bariatric surgery?

Yes, Medicare does cover gastric bypass surgery and laparoscopic banding surgery, but only if you are considered morbidly obese and meet certain conditions.

Blood?

Yes, under both Medicare Part A and Part B, depending on where you receive the blood (as a hospital inpatient or outpatient). If a hospital or provider has to buy blood for you, you are responsible for paying costs associated with the first three units of blood you receive in a calendar year.

Blood processing and handling?

Yes, under both Medicare Part A and Part B, depending on where you receive the blood.

Blood sugar (glucose) monitors?

Yes. Medicare Part B covers blood sugar monitors prescribed by your doctor.

Blood sugar (glucose) test strips?

Yes. Medicare Part B covers some test strips and other test supplies for people with diabetes.

Bone mass measurement?

Yes. Medicare Part B covers this bone density test once every 24 months unless more frequent tests are medically necessary. 

Braces (for an arm, leg, back or neck)?

Yes. Braces are covered under Medicare Part B, so long as they are deemed medically necessary.

Breast prostheses?

Yes. After a mastectomy, Medicare Part B covers an external breast prostheses and a post-surgical bra. If the surgery takes place while an inpatient is at a hospital, Medicare Part A covers it. If the surgery takes place in an outpatient setting, it is covered by Medicare Part B.

Canes?

Yes. Medicare Part B covers canes, but it does not cover white canes for the blind. For coverage purposes, canes are classified as durable medical equipment (DME).

Cardiac rehabilitation programs?

Yes. Medicare Part B covers cardiac rehabilitation programs if you are referred by your doctor. Programs include exercises, education and counseling to improve cardiac health.

Cardiovascular disease (behavioral therapy)?

Yes. Medicare Part B covers one visit per year in your primary care doctor’s office. Your doctor may assess your cardiovascular health at this visit, your doctor may discuss aspirin use, check your blood pressure or talk with you about your eating habits.

Cardiovascular disease screenings?

Yes. Medicare Part B covers various tests and screenings related to cardiovascular disease, including blood tests for cholesterol, lipid and triglyceride levels. Medicare covers these tests every five years when ordered by a doctor.

Cataract Surgery?

Yes, under Medicare Part A or Medicare Part B, depending on where the surgery takes place.

Cervical and vaginal cancer screenings?

Yes, under Medicare Part B. Part B covers these screenings once every 24 months for all women and once every 12 months for high-risk women.

Chemotherapy?

Yes. Chemotherapy is covered under either Medicare Part A or Medicare Part B, depending on where you receive treatment.

Chiropractic services?

Yes. Medicare Part B will cover chiropractic services, but only when they are medically necessary to correct a displaced bone in your spine (spinal subluxation).

Chronic care management services?

Yes, under Medicare Part B if you meet certain conditions. Speak with your health care provider to find out if they provide chronic care management services.

Clinical research studies?

Yes, Medicare Part A and Medicare Part B cover some costs associated with qualifying clinical research studies, including office visits and tests.

Colorectal cancer screenings?

Yes. Medicare Part B covers several types of colorectal screenings, including multi-target stool DNA tests, barium enema screening, colonoscopies and fecal occult blood tests.

Commode chairs?

Yes. When ordered by a doctor, commode chairs are covered by Medicare Part B.

Concierge care?

No.

Continuous passive motion (CPM) machine?

Yes. Medicare Part B covers CPM machines when prescribed by a doctor.

Cosmetic surgery?

No, unless the surgery is needed after accidental injury or to improve the function of a malformed body part.

Crutches?

Yes, under Medicare Part B.

CT scans?

Yes. If your doctor determines it is medically necessary to diagnose and treat a medical condition, Medicare Part B will cover a CT scan.

Custodial care?

No.

Defibrillators (implantable automatic)?

Yes. Medicare Part A or Medicare Part B will cover defibrillators, depending on where you have it implanted.

Dental services?

No, Medicare doesn’t cover routine dental care. Medicare Part A may pay for certain dental services received in a hospital setting.

Depression screenings?

Yes. Depression screenings are covered once a year under Medicare Part B.

Dermatologist check ups?

Yes. In some cases, Medicare Part B will cover dermatology if the visit is medically necessary to detect or treat a condition. Generally, Medicare Part B will also cover a visit to the dermatologist if it is preventative.  

Diabetes screenings?

Yes. Medicare Part B covers up to two screenings a year for eligible patients.

Diabetes self-management training?

Yes. Medicare Part B will cover up to 10 hours of training for certain people with diabetes who are at risk for complications.

Diabetes supplies and services?

Yes. Medicare Part B will cover some supplies and services for people with diabetes, including glucose test strips, insulin, lancet devices and therapeutic shoes or inserts.

Diagnostic tests?

Yes. When medically necessary and ordered by your doctor, Medicare Part B covers diagnostic tests.

Dialysis?

Yes. Medicare Part A or Medicare Part B will cover dialysis services and supplies depending on where you receive them. 

EKG (electrocardiogram) screening?

Yes. Medicare Part B covers an EKG screening one time with a referral from your doctor at your “Welcome to Medicare” preventive visit. EKGs are also covered as a diagnostic test.

End-Stage Renal Disease (ESRD)?

Yes. Original Medicare covers dialysis and other treatment for people with ESRD. If you have ESRD, you may be eligible to sign up for Medicare before age 65.

Enteral nutrition supplies and services (feeding pump)?

Yes, under Medicare Part B.

Eye exams?

Depends. Medicare does not cover routine eye exams, but Medicare Part B covers some diagnostic and preventative eye exams.

Eyeglasses and contact lenses?

No, unless it is one time after cataract surgery.

Flu shots?

Yes. Medicare Part B generally covers one flu shot per season.

Foot care?

Yes. Medicare Part B covers foot care when medically necessary.

Foot exams?

Yes. Medicare Part B covers a foot exam once every 6 months for eligible people.

Glaucoma tests?

Yes. For those at high risk for glaucoma, Medicare Part B covers this test once every 12 months.

Glucose control solutions?

Yes, under Medicare Part B.

Gym memberships or fitness programs?

No. However, some Medicare Advantage and Medicare Supplement Insurance plans may include such benefits.

Health care outside of the U.S. while traveling?

No, except in a few rare cases.

Health education and wellness programs?

No.

Hearing and balance exams ?

Yes. Medicare Part B covers these exams if ordered by your doctor to check to see if you need medical treatment.

Hearing aids?

No. Medicare does not cover hearing exams, hearing aids or hearing aid fittings.

Hepatitis B shots?

Yes, under Medicare Part B.

Hepatitis C screening test?

Yes. Medicare covers one Hepatitis C screening test and may cover up to one a year for certain high-risk patients.

Hernia surgery?

Yes. So long as the procedure is medically necessary, Medicare Part B will cover hernia surgery.

HIV screenings?

Yes. Medicare Part B covers this screening once every 12 months. Medicare Part B may also cover it up to three times while pregnant.

Home health services?

Yes. Medicare Part A and Medicare Part B cover some home health services, such as intermittent skilled nursing care, physical therapy, speech-language pathology services and continued occupational services for eligible people.

Hospice care?

Yes. Medicare will cover these services related to hospice care.

Hospital beds for home use?

Yes, under Medicare part B if prescribed by your doctor.

Humidifiers?

No, Medicare does not typically cover humidifiers unless medically necessary.

Hyperbaric oxygen (HBO) therapy?

Yes, under Medicare Part B if you have a qualifying condition.

Incontinence supplies or adult diapers?

No.

Infusion pumps and supplies?

Yes. Medicare Part B covers infusion pumps when medically necessary.

Insulin?

No. Medicare Part B does not typically cover insulin, but Medicare prescription drug coverage (Part D) may cover it.

Kidney disease education?

Yes. If you have Stage IV chronic kidney disease that will require dialysis or a kidney transplant, Medicare will cover up to six sessions of kidney disease education.

Kidney transplants?

Yes. Medicare Part A and Part B cover kidney transplant services.

Knee replacements?

Yes. Both Medicare Part A and Medicare Part B cover surgeries that are medically necessary, including knee replacements.

Laboratory services (clinical)?

Yes. Medicare Part B covers clinical diagnostic laboratory tests that are medically necessary, including blood tests, urinalysis, tissue-specimen tests and some screenings.

Lancet devices and lancets?

Yes, under Medicare Part B.

Liver transplants?

Yes. Both Medicare Part A and Part B cover services related to liver transplants.

Long-term care?

It depends. Medicare does not cover custodial care or other non-medical long-term care. Medicare does cover care in a long-term care hospital, skilled nursing care in a skilled nursing facility and hospice care.

Long-term care hospitals?

Yes. Medicare Part A covers long-term care hospitals.

Lung cancer screening?

Yes. Medicare Part B covers a lung cancer screening once a year.

Macular degeneration treatment?

Yes. Medicare Part B covers certain tests and treatments related to macular degeneration.

Mammograms?

Yes. Medicare Part B covers mammogram screenings once every 12 months and diagnostic mammograms whenever medically necessary.

Manual wheelchairs and power mobility devices?

Yes. Medicare Part B covers manual wheelchairs and power-operated wheelchairs when they are medically necessary.  

Massage therapy?

No.

Mental health care?

Yes. Medicare Part A and Medicare Part B cover mental health care, depending on where you receive it.

Naturopathic medicine?

No. Typically, Medicare does not cover alternative medicine.

Nebulizers and nebulizer medications?

Yes. Medicare Part B covers nebulizers and some medications used in nebulizers when medically necessary.

Nursing home care?

It depends. Medicare Part A covers care in a skilled nursing facility (SNF) when it is medically necessary. However, Medicare does not cover custodial care, which is the majority of care given in nursing homes. Medicare coverage depends on what kind of care you need.

Nutrition therapy services?

Yes. Medicare Part B covers nutrition therapy services to people who meet certain requirements.

Obesity screening and counseling?

Yes. Medicare Part B covers behavioral counseling sessions to help you lose weight in primary care setting.

Orthotics, artificial limbs and eyes?

Yes. Medicare Part B covers these when medically necessary.

Osteoporosis drugs?

Yes. Medicare Part A and Medicare Part B will cover an injectable osteoporosis drug for women, including a visit by a home health nurse to perform the injection.

Ostomy supplies?

Yes, under Medicare Part B.

Oxygen equipment and accessories?

Yes. Oxygen equipment and accessories are covered under Medicare Part B.

Pancreas transplants?

Depends. Medicare Part A and Part B will cover a pancreas transplant if you have End-Stage Renal Disease (ESRD) and the pancreas transplant occurs at the same time as, or after, a kidney transplant. Medicare rarely covers a pancreas transplant if you do not need a kidney transplant.

Patient lifts?

Yes. If your doctor prescribes you a patient lift for your home, it is covered under Medicare Part B.

Physical therapy, occupational therapy and speech-language pathology?

Yes. Medicare Part B covers these outpatient therapy services, but therapy cap limits may determine how much of these services Medicare will cover.

Pneumococcal shots?

Yes. Medicare Part B covers two pneumococcal shots: the first shot as well as a second shot one year later. Pneumococcal shots help prevent certain types of pneumonia.

Pre-existing conditions?

Yes. Original Medicare cannot deny you coverage based on a pre-existing condition.  

Prescription drugs?

Not usually. Generally, Original Medicare does not cover prescription drugs, but there are a few exceptions. For drug coverage, you can sign up for Medicare Part D.

Preventive visits?

Yes. Medicare Part B will cover one “Welcome to Medicare” preventive visit, but you must schedule it within the first 12 months of having Medicare Part B. After 12 months, you are eligible for one yearly wellness visit.

Prostate cancer screenings?

Yes. Medicare Part B covers a digital rectal exam and a prostate specific antigen (PSA) test once every 12 months.

Prosthetic devices?

Yes. Medicare Part B covers prosthetic devices when they are needed to replace a body part or function. Ostomy bags, breast prostheses and cochlear implants are also included in this coverage.

Pulmonary rehabilitation programs?

Yes. If you have moderate to severe chronic obstructive pulmonary disease (COPD), Medicare Part B will cover a pulmonary rehabilitation program.

Radiation therapy?

Yes. Medicare Part A and Medicare Part B cover radiation therapy, depending on where you receive therapy.

Rural health clinic services?

Yes. Medicare Part B covers outpatient primary care and preventative services at rural health clinics.

Second surgical opinions?

Yes. In some cases, Medicare Part B covers a second opinion for non-emergency surgeries. It may also cover a third opinion if the first and second opinions are different.

Sexually transmitted infections (STI) screening and counseling?

Yes. Medicare Part B covers STI screenings for chlamydia, gonorrhea, syphilis and Hepatitis B once a year. Additionally, Medicare will cover up to two face-to-face behavioral counseling sessions if you are at increased risk for an STI.

Shingles shot?

No. Original Medicare does not cover the shingles shot, but Medicare Part D (prescription drug plan) generally covers vaccines.

Skilled nursing facility (SNF) care?

Yes. Medicare Part A covers care provided in a skilled nursing facility for a limited time if you qualify and meet certain conditions.

Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices?

Yes. Medicare Part B covers a three-month trial of CPAP therapy. If your doctor demonstrates that the therapy is helping you with your sleep apnea, Medicare will continue to cover it after that.

Sleep studies?

Yes, under Medicare Part B. Medicare will cover Type I, II, III and IV sleep tests and devices. Type I tests need to be conducted in a sleep lab facility.

Smoking and tobacco use cessation?

Yes. Medicare Part B will cover up to eight in-person counseling visits in one year to help you stop smoking or using tobacco products.

Suction pumps?

Yes. Medicare Part B covers suction cups when prescribed by your doctor.

Surgery?

Yes. Original Medicare generally covers surgeries that are medically necessary.

Surgical dressing services?

Yes. Treatment of a surgical or surgically treated wound is covered under Medicare Part B, if medically necessary.

Tdap shots (tetanus, diphtheria and pertussis)?

No. Original Medicare does not cover this booster shot for adults and adolescents, but Medicare Part D generally covers vaccines.

Telehealth?

Yes. Medicare Part B will pay for certain services provided using a two-way telecommunications system that includes audio and video. If you live in some rural areas, these services are only covered from certain locations.

Therapeutic shoes or inserts?

Yes. If your doctor determines that you are eligible, Medicare Part B will cover one custom pair of therapeutic shoes and inserts every calendar year. 

Traction equipment?

Yes, under Medicare Part B.

Traditional care management services?

Yes. Medicare Part B may cover transitional care management if you are returning home after a stay in a hospital or skilled nursing facility (SNF).

Transplants?

Yes. Medicare Part A covers heart, lung, kidney, pancreas, intestine and liver transplants at Medicare-certified facilities. Medicare Part B covers the doctors services related to organ transplants. Original Medicare may also cover stem cell and cornea transplants.

Urgent care?

Yes. Medicare Part B covers urgent care.

Walkers?

Yes. Walkers, including rollators, are covered under Medicare Part B if they are medically necessary.

X-rays?

Yes. Medicare Part B covers X-rays when they are medically necessary for diagnosing a condition.

Vasectomies?

No.

Yearly eye exams?

Yes, but only for diabetic retinopathy. Original Medicare does not cover routine vision care.

Yearly wellness exams?

Yes. After one year of having Medicare Part B, you are eligible for one wellness visit a year. This visit may include routine measurements (blood pressure, height, weight, etc.), a review of your medical and family history or personalized health advice, among other services.

Medicare Supplement Insurance

Even as comprehensive as Original Medicare’s coverage is, it leaves some out-of-pocket costs to recipients. These costs include deductibles, copayments, coinsurance, excess charges and more.

Medicare Supplement Insurance (Medigap) helps cover certain Medicare out-of-pocket costs to help make your Medicare spending more predictable and affordable.

Speak to a licensed agent today at 888-264-0148 to review Medigap plans in your area and get a free, no-obligation quote.

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Source:

Medicare.gov

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