What Does Medicare Cover?

Medicare, the Federal program for the aged and disabled and those with End-Stage Renal Disease (ESRD) cover a lot – most “ordinary and medically necessary” treatments, hospital stays, doctor visits, and so on. Parts A and B (Original Medicare”) pays for prescription drugs and nursing home care only in very limited circumstances. (Part D of Medicare covers prescription drugs, and most nursing home care is paid for by Medicaid.)

How Can I Know If A Service I Want Is Covered?

The simplest way is to ask the insurer. They generally know what is covered and what is not. Another is to check the Medicare Coverage Page, The Centers for Medicare and Medicaid Services, which runs Medicare, issues new “coverage decisions” on what is and is not covered all the time. The coverage page is updated to take these into account.

What Medicare Doesn’t Cover?

There are a few broad classes of things Medicare doesn’t cover. Other services, such as speech and physical therapy, have limits on the number of sessions and require satisfactory progress.

Among things Original Medicare does not cover are (in no particular order):

• Surgery and treatments that are considered cosmetic and are intended to approve appearance rather than restore appearance found before an injury or illness;

• Nursing home care other than very short stays following hospitalization;

• Insulin and blood glucose testing supplies unless one has an implanted insulin pump;

• Most prescription drugs (if one does not have a Part D or Medicare Advantage Plan);

• Medical equipment not provided by a Medicare-approved supplier;

• Hearing aids;

• Most dental care;

• Eyeglasses except those needed following eye surgeries;

• Homeopathic medicines;

• Care outside the United States;

• Dietary supplements, unless prescribed to treat a deficiency;

• Custodial care that does not need to be provided by a medical professional;
• Transportation costs other than ambulances.

In addition, Medicare requires some procedures, such as organ transplants, to be provided only in facilities Medicare approves, even if the hospital in which they are done is Medicare approved. In other words, Medicare may not pay for your heart transplant unless it is performed in a hospital Medicare has specifically approved to do heart transplants.

How Can I Get Expanded Coverage?

Medicare Advantage Plans can offer some services that Medicare doesn’t cover. These include, staring in 2019, modifications to the home, meal services, prescription drugs, transportation other than by ambulance, and custodial care such as assistance with bathing and dressing. These are not covered under Original Medicare.

MedicareBenefits.us is not associated with the federal government. All plan information provided on this site is collected from public sources (e.g., cms.gov, carrier's website, plan brochures, etc.). Rates shown are for comparison purpose only. Contact your Medicare agent or Medicare.gov for a binding quote.