Medicare Part A and Part B cover a variety of services, including inpatient hospital care, skilled nursing care, preventive services, home health care and ambulance transportation. Additional services such as vision and dental care may be available through a Medicare Advantage plan.
What Services Are Covered by Medicare?
People enrolled in Original Medicare have access to a range of inpatient and outpatient services.
For example, Medicare Part A covers inpatient care in a hospital, home health care, skilled nursing facility care and hospice services.
Medicare Part B covers two main types of services: Medically necessary services or supplies and preventive services such as flu shots and cancer screenings. Clinical research, mental health services, durable medical equipment and ambulance transportation are all covered by Medicare Part B.
All Medicare Advantage plans are required to offer the same services as Original Medicare, but additional services such as dental and vision care may be offered.
Medicare Preventive Services
The majority of Medicare beneficiaries are 65 and older. It’s important for this age group to stay on top of their health care, including taking measures to prevent illness or detect diseases at an early stage when treatment is more effective.
Medicare Part B offers preventive services to help you stay healthy in retirement. Many of these tests or screenings are fully covered by Medicare, while some require cost-sharing for the beneficiary such as a copayment, coinsurance and a deductible.
Once you enroll in Medicare Part B — including enrollment through a Medicare Advantage plan — you have 12 months to receive a free “Welcome to Medicare” physical exam.
After you’ve been enrolled in Medicare Part B for a year, you are eligible for an annual wellness visit to build or update your prevention plan based on your current health and risk factors.
- Flu shots and vaccines
- Lab tests and screenings
- Cancer screenings, including mammograms and prostate exams
- Diabetes screenings and self-management training
- Bone mass measurements
- Health monitoring, counseling and education
- Nutrition therapy services
- Welcome to Medicare preventive visit and yearly wellness visit
Medicare Part B covers ambulance services in emergencies and some nonemergency scenarios.
Transportation by ambulance is covered to the nearest hospital, critical access hospital or skilled nursing facility appropriate for your emergency. Medicare may deny covering your ambulance service if it is determined that you could have safely traveled by other means of transportation, such as by car or taxi.
Medicare only covers ambulance service to the closest facility appropriate for your condition.
Limited nonemergency ambulance services and air ambulance services may be covered if you have a written order from your doctor saying it is medically necessary.
Medicare beneficiaries are responsible for 20 percent of the Medicare-approved cost of all ambulance services after meeting their Part B deductible.
Medicare Part A covers skilled nursing care that’s not custodial or long-term care. Hospice services are also covered, usually at no cost to you.
Original Medicare also covers select home health care services for eligible beneficiaries.
- Occupational therapy
- Medical social services
- Speech-language pathology services
- Physical therapy
- Part-time skilled nursing care
- Part-time home health aides
It is important to understand the difference between home health care and custodial care. Medicare does not cover 24-hour-a-day care. It also won’t cover homemaker services or personal care services if that’s all you require.
Services Not Covered by Medicare
There are certain services that Original Medicare does not cover, including long-term care and medical care overseas.
Enrolling in a Medicare Advantage plan may provide coverage of routine vision, dental or hearing care. Beneficiaries in need of prescription drug coverage can enroll in a Medicare Part D plan.
- Long-Term Care
- Medicare covers short-term stays in skilled nursing facilities as well as some home health care services. Medicare does not pay for long-term care, also known as custodial care. This includes extended stays in a nursing home or assisted living facility.
- Prescription Drugs
- Limited outpatient prescription drugs are covered by Medicare Part B. You can enroll in a Medicare Part D plan to cover other prescriptions. Costs and what drugs are covered vary by plan.
- Vision, Dental and Hearing
- Original Medicare does not cover routine vision, dental and hearing services. This includes teeth cleanings, eye exams and hearing aids. Some Medicare Advantage plans cover these services. You also have the option to purchase a separate dental insurance policy, dental discount plan or vision insurance.
- International Travel
- Medicare only covers medical care outside of the United States in rare, emergency circumstances. Some Medicare Supplement plans may cover up to 80 percent of the billed charges for emergency services outside the U.S.
10 Cited Research Articles
- American Cancer Society. (2019, May 13). Medicare Coverage for Cancer Prevention and Early Detection. Retrieved from https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-health-insurance/government-funded-programs/medicare-medicaid/medicare-coverage-for-cancer-prevention-and-early-detection.html
- Lankford, K. (2018, May 23). 7 Things Medicare Doesn’t Cover. Retrieved from https://www.kiplinger.com/slideshow/retirement/t039-s001-7-things-medicare-doesn-t-cover/index.html
- AARP. (n.d.). What is the “Welcome to Medicare” checkup? Retrieved from https://www.aarp.org/health/medicare-qa-tool/whats-a-medicare-wellness-visit/
- Centers for Medicare & Medicaid Services. (n.d.). Your Guide to Medicare Preventive Services. Retrieved from https://www.medicare.gov/Pubs/pdf/10110-Medicare-Preventive-Services.pdf
- Medicare.gov. (n.d.). What Part B Covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-b-covers
- Medicare.gov. (n.d.). What Part A Covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-a-covers
- Medicare.gov. (n.d.). Hospice Care. Retrieved from https://www.medicare.gov/coverage/hospice-care
- Medicare.gov. (n.d.). Diagnostic Laboratory Tests. Retrieved from https://www.medicare.gov/coverage/diagnostic-laboratory-tests
- Medicare.gov. (n.d.). Preventive screening services. Retrieved from https://www.medicare.gov/coverage/preventive-screening-services
- Medicare.gov. (n.d.). Yearly “Wellness” visits. Retrieved from https://www.medicare.gov/coverage/yearly-wellness-visits