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:
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:
- Medicare Coverage for Alzheimer’s Disease
- Does Medicare Cover Assisted Living?
- What Is Medicare Chronic Care Management?
- Managing Diabetes on Medicare
- ESRD Medicare (End-stage Renal Disease): What to Expect
- Does Medicare Cover Home Health Care?
- Does Medicare cover Hospice?
- Does Medicare Cover Long-Term Care?
- Multiple Sclerosis and Medicare Coverage
- Does Medicare Pay for Nursing Homes?
- Does Medicare Cover Treatment for Parkinson’s Disease?
- Does Medicare Cover Palliative Care?
- Does Medicare Cover Pre-Existing Conditions?
- Does Medicare Pay for Respite Care?
- Medicare Skilled Nursing Facility (SNF) Coverage
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
- Does Medicare Cover Diabetic Test Strips?
- 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?
- Medicare Coverage for Nebulizers
- Does Medicare Cover Orthotics?
- Medicare Oxygen Equipment Coverage
- Medicare and Prosthetics: Legs, Eyes, and Other Prosthesis Coverage
- Does Medicare Cover Mobility Scooters and Wheelchairs?
- 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:
- Does Medicare Help Treat Anxiety in Older Adults?
- Does Medicare Cover Antidepressants?
- What You Need to Know About COVID-19 and Medicare
- Does Medicare Cover Immunosuppressive Drugs?
- Does Medicare Cover Insulin?
- Medicare Coverage and Medical Marijuana
- Does Medicare Cover Paxlovid?
- Medicare Online Pharmacy Coverage
- Prescription Coverage for Medicare
- Does Medicare Cover Weight Loss Drugs Like Ozempic or Mounjaro?
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:
- Welcome to Medicare Preventive Visit
- Medicare Annual Wellness Visit
- Does Medicare Cover Annual Physicals?
- Medicare Helps With an Aging Heart
- How Medicare Can Help With Allergies
- Does Medicare Cover Allergy Testing?
- How Medicare Helps To Reach Your Target Blood Pressure
- Does Medicare Cover Colonoscopy Exams?
- Does Medicare Cover the COVID Vaccine?
- Does Medicare Cover Dermatology?
- Does Medicare Cover DNA Testing?
- Does Medicare Cover Flu Shots?
- Does Medicare Cover the Hepatitis A Vaccine?
- Medicare Hepatitis B Vaccine Shot Coverage
- Medicare Hepatitis C Screening Coverage
- Does Medicare Cover HIV Treatment?
- Does Medicare Cover Lab Work and Blood Tests?
- Does Medicare Cover Mammograms?
- Does Medicare Cover Meningitis Prevention and Treatment?
- Does Medicare Cover an MRI?
- Does Medicare cover Pap Smears, Pelvic & Breast Exams?
- Does Medicare Cover a Prostate Biopsy and Cancer Screening?
- Does Medicare Cover Pneumonia Shots?
- Does Medicare Cover the Shingles Vaccine?
- Does Medicare Cover Telehealth & Telemedicine?
- Will Medicare Cover Telehealth in 2025?
- Does Medicare Cover X-rays?
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
- Medicare Behavior Change Model Targets Type 2 Diabetes Prevention
- Does Medicare Cover Obesity Counseling?
- Is Occupational Therapy Covered by Medicare?
- Does Medicare Cover Physical Therapy?
- Does Medicare Cover Smoking Cessation?
- Medicare Speech Therapy and Speech Language Pathology Coverage
- Does Medicare Cover Therapy?
- Medicare Coverage for Traumatic Brain Injury
- Does Medicare Cover Medical Nutrition Therapy?
- Mental Health Coverage with Medicare
- Does Medicare Cover Psychotherapy?
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
- Medicare Dialysis Services Coverage
- Does Medicare Cover Knee Replacement Surgery?
- Does Medicare Cover Hip Replacements?
- Medicare Hospital Coverage
- Does Medicare Cover Oral Surgery? What to Know
- Medicare Organ Transplant Coverage
- Medicare Coverage for Radiation Therapy?
- Does Medicare Cover Surgery?
- Medicare and Second Opinions Before Surgery
- Does Medicare Cover Weight Loss or Bariatric Surgery?
Emergency and urgent care
Medicare covers emergency room visits for a medical emergency, but coverage for some services like ambulance rides may vary.
Further reading:
Health and wellness
Understanding your coverage options through Original Medicare and Medicare Advantage plans can help you make informed decisions about your health.
Further reading:
- Medicare and Mental Health
- Our Top 5 Healthy Aging Tips for Men
- Why Medicare Matters for Women’s Health
- Does Medicare Cover Acupuncture?
- Does Medicare Cover Chiropractic Services?
- Is There a Medicare Death Benefit to Cover Funeral Expenses?
- What Is a Medicare Flex Card?
- Does Medicare Cover Gym Memberships?
- Ways People on Medicare Manage Loneliness
- What Is a Medicare PACE Program?
- Does Medicare Cover Weight Loss or Bariatric Surgery?
- Medicare Coverage for Traumatic Brain Injury
- Does Medicare Cover Medical Nutrition Therapy?
- Mental Health Coverage with Medicare
- Does Medicare Cover Psychotherapy?
Chronic Condition Special Needs Plan (CSNP) coverage
A Chronic Condition Special Needs Plan (C-SNP, or CSNP) is a Medicare Advantage plan type that serves people with severe chronic health conditions. A CSNP offers specialized care to treat and manage long-term conditions, including those listed below.
Further reading:
- Autoimmune disorders
- Cancer
- Cardiovascular disorders
- Chronic and disabling mental health conditions
- Chronic dependence on alcohol or other drugs
- Chronic heart failure
- Chronic lung disorders
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) if it requires dialysis
- HIV/AIDS
- Neurologic disorders, including:
- Severe hematologic disorders
- Stroke
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