“What does Medicare cover” is an extremely important question. If you don’t know what is and is not covered under Medicare, you cannot adequately manage your healthcare costs. That’s why we’re here, to help answer those questions below.
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What Does Medicare Cover and Not Cover?
There are different factors that dictate what Medicare does and does not cover. Some of these factors include:
- Federal or state laws deciding what services a healthcare practitioner is licensed to provide
- National policy decisions made by Medicare stating whether a particular service or item is nationally covered based on current Medicare rules
- Local policy decisions made by local companies in each state that process Medicare claims
Additionally, there are other Medicare rules and policies requiring certain services or items to be covered under specific circumstances or medical conditions. For example, organ transplant surgery can only be performed in certain Medicare-approved hospitals. Also, if you have a Medicare Advantage plan or other Medicare health plans, the rules may differ. It’s always important that you talk to your doctor or healthcare provider so you have a clear understanding of whether that service or item is covered under your Medicare plan.
Which Medical Services Does Medicare Cover?
There are different parts of Medicare that help cover specific healthcare services. Generally, Medicare covers services such as lab tests, surgeries, and doctor visits. Additionally, Medicare covers medically necessary equipment like wheelchairs and walkers used to treat a disease or medical condition. However, coverage varies depending on the Medicare plan. Here’s a quick overview of the different Medicare plans:
- Medicare Part A: Provides hospital and inpatient coverage
- Medicare Part B: Provides coverage for doctor visits and outpatient services
- Medicare Part C: Private option that combines Medicare Part A and Part B, as well as other additional benefits like Part D into one plan
- Medicare Part D: Provides prescription drug coverage
- Medicare Supplement Plan (Medigap): Another private option that helps fill “gaps” in Medicare Part A and Part B coverage
Does Medicare Cover Acupuncture?
Medicare only covers acupuncture for chronic lower back pain. For more information, please visit: does Medicare cover acupuncture?
Does Medicare Cover Ambulance?
Medicare Part B covers most of the costs associated with ambulance transportation to a medical facility. For more information, please visit: does Medicare cover ambulance services?
Does Medicare Cover Assisted Living?
Medicare does not cover the cost of assisted living care, but some Medicare Advantage plans do. For more information, please visit: does Medicare cover assisted living?
Does Medicare Cover Cancer?
Medicare covers any cancer treatment that is deemed medically necessary, including chemotherapy.
Does Medicare Cover Colonoscopy?
Medicare does cover the cost of colonoscopies once every 120 months and more frequently for patients who are at high risk of colorectal cancer. For more information, please visit: does Medicare cover colonoscopy?
Does Medicare Cover COVID Testing & Treatment?
Medicare does cover the cost of COVID testing. Medicare will also cover COVID treatment, but there’s a little bit more details that need to be explained. For information, please visit: does Medicare cover COVID testing and treatment?
Does Medicare Cover Custodial Care?
Medicare does not cover custodial care, though some Medicare Advantage plans do.
Does Medicare Cover Erectile Dysfunction?
Unfortunately, Medicare Part A and Part B does not cover erectile dysfunction, but Medicare Advantage may help with payment. Medicare Part D may also help as well.
Does Medicare Cover Hearing Aids?
Unfortunately, Medicare does not cover hearing aids. Medicare also does not cover hearing exams. However, some Medicare Advantage plans do cover hearing-related care.
Does Medicare Cover International Travel?
In most cases, Medicare does not cover international travel care. If you are out of the country or planning to travel abroad, you will probably need to pay the full price for any care you receive.
Does Medicare Cover Ovarian Cancer?
Medicare may cover some of the treatment costs for ovarian cancer. Medicare Part A covers most hospital stays. Medicare Part B covers outpatient services which includes some ovarian cancer treatments.
Does Medicare Cover Pre-Existing Conditions?
Yes, Medicare does cover all pre-existing conditions.
Does Medicare Cover Shingles Vaccine (Shingrix)?
To get coverage for Shingrix (or another form of shingles vaccine), you will need to have Medicare Prescription Drug (Part D) coverage. For more information, please visit: does Medicare cover shingles vaccine?
Does Medicare Cover SilverSneakers?
Medicare does not cover fitness programs like SilverSneakers, though some Medicare Advantage plans do.
Does Medicare Cover Surgery?
Medicare covers most surgeries that are deemed “medically necessary.” Part A covers inpatient surgeries, while Part B covers outpatient surgeries. For example, eye surgery can be covered by Medicare even though Medicare does not typically cover “vision” care, as long as the surgery is required to retain or repair sight (cataracts, glaucoma, etc). However, Original Medicare does not cover laser eye surgery.
Does Medicare Cover Dental?
Typically, Medicare Part A and Part B (Original Medicare) does not cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. There are some exceptions to this rule, such as an emergency or complicated dental procedure that requires a hospital stay. For dental coverage, the best option is a Medicare Advantage plan, which covers routine dental services, such as checkups or cleanings.
Does Medicare Cover Dental Implants?
Unfortunately, Medicare Part A and Part B does not cover dental implants. However, some Medicare Advantage plans may include dental. For more information, please visit: does Medicare cover dental implants?
Does Medicare Cover Dental Expenses?
Medicare Part A and Part B (Original Medicare) does not cover most dental care, dental procedures, supplies or even cleanings, fillings or other dental services. However, Medicare Part A may cover certain dental services when in the hospital.
Does Medicare Cover Dentures?
Medicare does not cover dentures, but some Medicare Advantage plans may provide coverage. If you’re going to the dentist or know that you will have dental expenses, it’s best to seek out a Medicare Advantage plan that covers dental care.
Does Medicare Cover Root Canals?
Medicare Part A and Part B (Original Medicare) does not cover root canals, though some Medicare Advantage plans do.
Does Medicare Cover Tooth Extractions?
Medicare Part A and Part B (Original Medicare) does not cover most tooth extractions, though some Medicare Advantage plans do.
Does Medicare Cover Vision?
Medicare Part A and Part B (Original Medicare) offer limited vision coverage related to particular chronic conditions. Routine vision exams, eye refractions, and most vision corrections are not covered by Medicare. Unless beneficiaries have other vision coverage, they are responsible for 100% of vision costs and eye care. For vision coverage, the best option is a Medicare Advantage plan, which includes full coverage for routine vision exams, vision correction products, and other vision care. For more information, please visit: does Medicare cover vision?
Does Medicare Cover Cataract Surgery?
In short, Medicare does cover cataract surgery, as long as it is medically necessary.
Does Medicare Cover Eye Exams?
Medicare Part A and Part B (Original Medicare) does not cover eye or vision exams, but some Medicare Advantage plans do cover eye care. For more information, please visit: does Medicare cover eye exams?
Does Medicare Cover Eye Surgery?
This varies. Medicare covers cataract surgery but does not cover laser eye surgery (LASIK) or other elective surgeries. However, if you have a chronic eye condition like glaucoma, Medicare covers certain surgical procedures.
Does Medicare Cover Glasses?
Medicare Part A and Part B does not cover the cost of vision care or eyeglasses, but some Medicare Advantage plans do. For more information, please visit: does Medicare cover glasses?
Does Medicare Cover Laser Eye Surgery?
Medicare does not cover Laser Eye Surgery (LASIK) or other elective surgeries.
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