What does Medicare cover?
Understanding your Medicare coverage will help you get the care and preventive services you need for a healthier, happier life.
How does Medicare coverage work?
Original Medicare, the federal health insurance program for people who are 65 or older or have certain disabilities, consists of two parts: Part A (hospital insurance) helps with inpatient care, while Part B (medical insurance) covers outpatient services and preventive care. With Original Medicare, you can visit any provider that accepts Medicare nationwide.
Once you enroll in Parts A and B, you have options to enhance your coverage.
Tip: Original Medicare doesn’t cover everything. Coverage isn’t included for most prescription drugs and services like long-term care, most dental care, eye exams for glasses, and cosmetic surgery.
Exploring coverage options
After enrolling in Original Medicare, you have choices to expand your coverage. You can add a Part D plan for prescription drugs and a Medicare Supplement plan to fill coverage gaps.
Another option is Medicare Advantage (Part C). These plans substitute for Original Medicare, offering all Part A and B benefits through a private insurer. Many include Part D drug coverage and additional benefits.
Tip: Most Medicare Advantage plans use provider networks, which will limit your choice of doctors.
Further reading:
- Medicare Part C Coverage
- Medicare Part D Prescription Drug Coverage
- All About Medicare Supplement Insurance (Medigap) Coverage
- What’s Happening to Medicare Advantage Benefits in 2025?
- How Can You Tell if a Medicare Plan is the Right Fit for You?
- Qualified for Disability? Explore Your Medicare Coverage Options
How does Medicare decide what to cover?
Medicare coverage and costs are determined by federal and state laws, national coverage decisions, and local coverage decisions based on medical necessity.
Tip: Medicare Advantage plans must at least match the coverage you would get from Original Medicare and may include additional benefits.
Further reading:
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Medicare coverage and benefits
Chronic and long-term care
Medicare covers many services for chronic conditions, including doctor visits, lab tests, and some home health care. While it doesn’t cover long-term care in nursing homes, it does provide limited coverage for skilled nursing facility care.
Further reading:
Dental and vision
Original Medicare doesn’t cover most routine dental and vision care, but does cover some medically necessary dental procedures and vision tests related to specific conditions. Medicare Advantage plans may provide dental and vision coverage.
Further reading:
Medical equipment and supplies
Medicare covers durable medical equipment like wheelchairs, walkers, and hospital beds when medically necessary. It also covers some supplies such as diabetes test strips. You’ll typically pay 20% of the Medicare-approved amount for these items after meeting your Part B deductible.
Further reading:
- Does Medicare Cover Blood Pressure Monitors?
- Does Medicare Cover CPAP Machines?
- Medicare Coverage for Internal Defibrillators and LifeVest
- Everything You Need to Know About Medicare Diabetes Supplies
- Medicare DME Coverage
- Medicare CGM Coverage: Coverage for Insulin Pumps & Continuous Glucose
- Does Medicare Cover Hearing Aids?
- Does Medicare Pay for Incontinence Supplies Like Adult Diapers?
- Medicare Dialysis Services Coverage
- Does Medicare Cover Lift Chairs?
- Does Medicare Cover Orthotics?
- Medicare Oxygen Equipment Coverage
- Medicare and Prosthetics: Legs, Eyes, and Other Prosthesis Coverage
- Does Medicare Cover Mobility Scooters and Wheelchairs?
- Medicare Coverage for Nebulizers
- Does Medicare Cover Walkers & Canes?
Medication and prescription drugs
Original Medicare doesn’t cover most prescription drugs. If you don’t have prescription drug coverage from another source, you’ll need to enroll in a Medicare Part D plan or a Medicare Advantage prescription drug plan. These plans help cover the cost of both generic and brand-name drugs, though coverage and costs vary by plan.
Further reading:
Miscellaneous
Understanding your coverage options through Original Medicare and Medicare Advantage plans can help you make informed decisions about your health.
Further reading:
- Does Medicare Cover Acupuncture?
- Does Medicare Cover Emergency Room Visits?
- Is There a Medicare Death Benefit to Cover Funeral Expenses?
- Does Medicare Cover Gym Memberships?
- Medicare Hospital Coverage
- Does Medicare Cover Pre-Existing Conditions?
- Get On Track: Railroad Retirement and Social Security
- Does Medicare Cover Telehealth & Telemedicine?
- Medicare Transportation Coverage & Ambulances Services Coverage
- Medicare & Urgent Care: What’s Covered as a Medicare Beneficiary?
Preventive care and screening services
Medicare covers a wide range of preventive services at no cost to you, including annual wellness visits, various cancer screenings, flu shots, and other vaccinations. These services can help detect health issues early, when they’re most treatable.
Further reading:
- Medicare Annual Wellness Visit
- Does Medicare Cover the COVID Vaccine?
- Does Medicare Cover Flu Shots?
- Does Medicare Cover the Hepatitis A Vaccine?
- Does Medicare Cover Mammograms?
- Does Medicare cover Pap Smears, Pelvic & Breast Exams?
- Does Medicare Cover Annual Physicals?
- Does Medicare Cover Pneumonia Shots?
- Does Medicare Cover the Shingles Vaccine?
- Our Top 5 Healthy Aging Tips for Men
- Why Medicare Matters for Women’s Health
Therapy and rehabilitation
Medicare covers physical therapy, occupational therapy, and speech-language pathology services when they’re medically necessary. There are limits on how much Medicare pays for these services in some settings.
Further reading:
- Medicare Cardiac Rehabilitation Coverage
- Does Medicare Cover Chiropractic Services?
- Does Medicare Cover Medical Nutrition Therapy?
- Medicare Behavior Change Model Targets Type 2 Diabetes Prevention
- Mental Health Coverage with Medicare
- Does Medicare Cover Obesity Counseling?
- Is Occupational Therapy Covered by Medicare?
- Does Medicare Cover Physical Therapy?
- Medicare Speech Therapy and Speech Language Pathology Coverage
- Does Medicare Cover Therapy?
Treatment and surgery
Original Medicare covers a wide range of medically necessary treatments and surgeries, with Part A covering inpatient procedures and Part B covering outpatient care. Medicare Advantage plans must provide at least the same coverage for these services as Original Medicare, but they may require you to use in-network providers to get the most from your benefits.
Further reading:
- Does Medicare Cover Cancer Treatment?
- Does Medicare Cover Cataract Surgery?
- Does Medicare Cover Chemotherapy? Understanding the Costs
- Does Medicare Cover Knee Replacement Surgery?
- Does Medicare Cover Oral Surgery? What to Know
- Medicare Organ Transplant Coverage
- Medicare Coverage for Radiation Therapy?
- Does Medicare Cover Surgery?
- Does Medicare Cover Weight Loss or Bariatric Surgery?
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