Medicare covers services (including lab tests, surgeries, and doctor visits) and supplies (including wheelchairs and walkers) considered medically necessary to treat a disease or condition. If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
In general, Part A covers:
- Hospital care
- Skilled nursing facility care
- Nursing home care (as long as custodial care isn’t the only care you need)
- Home health services
Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessaryto treat a disease or condition. If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
Part B covers 2 types of services
Medically-necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.
Part B covers services/supply including:
- Clinical research
- Ambulance services
- Durable medical equipment
- Mental health
- Partial hospitalization
- Getting a second opinion before surgery
- Limited outpatient prescription drugs
Medicare coverage is based on 3 main factors
1. Federal and state laws.
2. National coverage decisions made by Medicare about whether something is covered.
3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or you’re in a Medicare health plan that covers these services.
Some of the items and services that Medicare doesn’t cover include:
- Long-term care (also called custodial care)
- Routine dental or eye care
- Cosmetic surgery
- Hearing aids and exams for fitting them
- Routine foot care
Complete Medicare information at the official U.S. government Medicare site