What Does Medicare Cover?

Medicare covers screening and medically necessary diagnostic mammograms. CMS also provides billing codes for screening and diagnostic 3D mammography.

Medicare Part B covers bone mass measurements for eligible people, generally once every 24 months or more often when medically necessary.

Medicare Part B covers qualifying multi-target stool DNA screening tests, including covered at-home tests, once every three years.

Medicare Part B covers screening colonoscopies. Frequency depends on risk and prior screening, and medically necessary diagnostic procedures follow different cost rules.

Medicare Part B covers the seasonal flu vaccine, usually once each flu season, without cost when the provider accepts assignment.

The hepatitis A vaccine is generally covered through Medicare Part D when it is recommended to prevent illness under current adult immunization guidance.

Medicare Part B covers pneumococcal vaccines without cost when the provider accepts assignment. A clinician should determine the appropriate vaccine schedule.

Medicare Part D covers the shingles vaccine with no deductible, copayment, or coinsurance when the vaccine is furnished under Part D rules.

Medicare Part D covers the Tdap vaccine with no deductible or cost sharing when it is furnished under the drug plan’s coverage procedures.

Medicare Part B covers a limited course of acupuncture for qualifying chronic low back pain. It does not provide general acupuncture coverage for other conditions.

Medicare Part B covers medically necessary ambulance transportation when travel in another vehicle could endanger the patient’s health.

Medicare covers certain bariatric surgery procedures for people who meet Medicare’s medical eligibility requirements.

Medicare covers qualifying ambulatory blood pressure monitoring as a diagnostic test. A standard home blood pressure cuff is not generally covered as ordinary DME.

Medicare Part B covers medically necessary diagnostic laboratory tests ordered by a qualified health care provider and covers certain preventive blood tests.

Medicare covers many medically necessary cancer services, including inpatient care, outpatient treatment, chemotherapy, radiation, tests, and certain drugs.

Medicare Part B may cover medically necessary cataract surgery with a conventional intraocular lens and one pair of standard corrective lenses afterward.

Medicare covers chemotherapy for cancer. Part A or Part B applies based on whether treatment is inpatient or outpatient, and Part D may cover certain drugs.

Medicare Part B covers manual manipulation of the spine by a chiropractor to correct a vertebral subluxation. It does not cover most other chiropractic services.

Medicare does not guarantee coverage for COOLIEF by brand name. Coverage depends on the billed procedure and local rules.

Medicare Part B covers medically necessary outpatient mental health counseling from eligible Medicare providers, including mental health counselors and marriage and family therapists.

Medicare Part B covers medically necessary dermatology services. Routine cosmetic treatment and removal of harmless lesions for appearance are not covered.

Medicare covers eligible inpatient, outpatient, and home dialysis services and supplies for people with End-Stage Renal Disease and certain acute kidney injuries.

Medicare Part B usually covers emergency department services for a sudden illness, injury, or condition that quickly becomes worse.

Medicare covers many medically necessary eye surgeries and treatments, but it does not generally cover routine eye care or surgery performed only to reduce dependence on glasses.

Medicare covers medically necessary knee replacement surgery. Costs depend on inpatient or outpatient status and related services.

Original Medicare does not cover massage therapy as a stand-alone service. It may cover medically necessary therapy services, but that is a different benefit.

Medicare covers eligible inpatient and outpatient mental health services, including counseling, psychiatric care, certain structured programs, and many prescription drugs.

Medicare Part B covers medically necessary MRI scans ordered to diagnose or treat a medical condition. The imaging provider must meet Medicare requirements.

Medicare may cover oral surgery when it is medically necessary and connected to a covered medical service. It generally does not cover routine dental surgery or tooth replacement.

Medicare Part B covers medically necessary outpatient physical therapy with no annual payment limit.

Medicare does not publish product-specific coverage for Quell. TENS coverage depends on the device, prescription, diagnosis, and policy.

Medicare Part B covers qualifying sleep tests ordered to evaluate clinical signs and symptoms of sleep apnea.

Medicare covers specified hematopoietic stem cell transplants for certain diseases and circumstances. It does not provide broad coverage for treatments marketed as regenerative stem cell therapy.

Original Medicare covers limited bathroom equipment. Most safety and convenience items are not covered.

Medicare Part B covers certain medically necessary arm, leg, back, and neck braces ordered by a provider.

Part B covers prescribed compression treatment items for diagnosed lymphedema. Ordinary support stockings remain noncovered.

Medicare Part B may cover a CPAP machine and supplies for eligible people with obstructive sleep apnea.

Medicare Part B covers qualifying blood glucose monitors, test strips, lancets, and control solutions.

Medicare may cover a qualifying continuous glucose monitor and supplies when current eligibility rules are met.

Original Medicare does not cover adult diapers, briefs, pads, or other common incontinence supplies.

Medicare covers home INR monitoring for certain people who use warfarin and meet national coverage requirements.

Original Medicare does not cover telephone-based medical alert systems such as Life Alert.

Medicare Part B covers medically necessary oxygen equipment, including equipment that meets documented mobility needs.

Medicare covers medically necessary podiatry and limited orthotic items. Routine foot care is generally not covered.

Medicare may cover the seat-lift mechanism when strict criteria are met. It does not cover the chair itself.

Medicare Part B covers qualifying mobility scooters needed for daily activities inside the home.

Original Medicare does not cover stair lifts or stairway elevators because they are home modifications, not DME.

Original Medicare does not generally cover walk-in tubs, bathtub lifts, or bathroom remodeling.

Medicare Part B covers medically necessary walkers and rollators ordered for use in the home.

Original Medicare does not cover wheelchair ramps or other structural home modifications.

Original Medicare does not pay the room, board, or custodial care charges of an assisted living facility. It may continue to cover eligible medical services received while a person lives there.

Medicare covers certain part-time or intermittent home health services for eligible people who are homebound and need skilled care under a provider-certified plan.

Medicare Part A covers hospice care for eligible people who are certified as terminally ill and choose comfort care for the terminal illness and related conditions.

Medicare does not cover long-term custodial nursing home care. Part A may cover a limited stay in a Medicare-certified skilled nursing facility when all requirements are met.

Medicare can cover medically necessary services used in palliative care. Coverage depends on the individual service and differs from the Medicare hospice benefit.

Medicare covers medically necessary rehabilitation in inpatient, skilled nursing, outpatient, and home health settings when the applicable requirements are met.

Original Medicare generally does not cover routine dental care or routine eye exams for glasses. It covers certain dental and eye services that meet specific medical requirements.

Original Medicare does not cover dentures. Some Medicare Advantage plans may provide a dental allowance or other denture benefit subject to plan rules.

Medicare drug coverage may cover Entresto when it is on the plan’s formulary. Coverage rules and cost depend on the specific Part D or Medicare Advantage drug plan.

Original Medicare does not cover gym memberships or general fitness programs. Some Medicare Advantage and other private plans offer a fitness benefit.

Original Medicare does not cover hearing aids or examinations used only to fit hearing aids. Part B can cover diagnostic hearing and balance examinations in defined circumstances.

Medicare covers insulin through Part D or, for insulin used with a covered durable insulin pump, through Part B. Covered insulin costs no more than $35 for a one-month supply.

A person who never worked may still qualify for Medicare. Work history mainly affects whether Part A has a monthly premium, not basic age-based eligibility for Part B.

Original Medicare and Medicare Advantage cover eligible services for pre-existing conditions. Medigap enrollment and waiting-period rules require separate attention.

Medicare coverage is individual, not a family plan. A spouse’s work record can affect premium-free Part A, and current employer coverage can affect Part B enrollment timing.

Part D generally excludes Viagra or sildenafil when prescribed to treat erectile dysfunction. Coverage may differ when sildenafil is prescribed for another FDA-approved indication.