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 offers additional services such as dental and vision care.
Medicare Preventive Services
Most 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 others require cost-sharing for the beneficiary such as a copayment, coinsurance and a deductible.
Once you enroll in Medicare Part B, you have 12 months to receive a free “Welcome to Medicare” physical exam, according to AARP.
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
Preventive Vaccine Coverage
Vaccines are included under Medicare’s preventive services. Beneficiaries are covered for several preventive vaccines, including an annual flu shot. Medicare typically pays for the entire cost of the vaccine if it’s under coverage.
While Medicare does not cover all vaccines, some can be received if they are related to the treatment of a condition. Other vaccines are available through Part D prescription drug plans.
Durable Medical Equipment Under Medicare
Medicare does cover durable medical equipment (DME). DME is typically a non-disposable item or type of equipment that assists with a medical condition. Examples include wheelchairs, canes or walkers, all of which Medicare can cover.
Medicare typically will not cover any disposable, temporary items or equipment that’s more substantial, like a hospital bed.
- Hospital beds
As with other items covered by Medicare, DME must be considered medically necessary for you to use for it to be covered.
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 Medicare Part D or Medicare Advantage with prescription drug coverage to cover other prescriptions. Costs and what drugs are covered vary by plan.
- 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% of the billed charges for emergency services outside the U.S.
Medicare Coverage of Dental Services
Medicare generally does not include any coverage for dental services. This means basic items and services like dentures or regular cleanings and checkups are not covered.
There are some dental services that can be covered in unusual circumstances, like if a tooth extraction is needed to prepare for radiation treatment. Dental coverage is often available through a Medicare Advantage plan.
Medicare Coverage of Hearing Services
Hearing is typically excluded from Medicare coverage. This means that hearing aids and exams to fit them will not be covered. Similar to dental, hearing coverage is often included in Medicare Advantage plans.
Medicare Coverage of Vision Services
Medicare does not include vision coverage. Beneficiaries will have to pay out-of-pocket for any routine eye examinations. Glasses or contacts are also not covered. However, Medicare can cover some eye treatments related to medical conditions, such as macular degeneration.
Vision coverage is typically available through a Medicare Advantage plan.
Medicare Coverage of Ambulance Services
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% of the Medicare-approved cost of all ambulance services after meeting their Part B deductible.
Medicare Coverage of Specialty Care
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 care. It also won’t cover homemaker services or personal care services if that’s all you require.
Frequently Asked Questions
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. (2021, November 16). 7 Things Medicare Doesn’t Cover. Retrieved from https://www.kiplinger.com/retirement/medicare/601489/7-things-medicare-doesnt-cover
- 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/sites/default/files/2021-08/10110-Your-Guide-to-Medicare-Preventive-Services.pdf
- Centers for Medicare & Medicaid Services. (n.d.). What Part B Covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-b-covers
- Centers for Medicare & Medicaid Services. (n.d.). What Part A Covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-a-covers
- Centers for Medicare & Medicaid Services. (n.d.). Hospice Care. Retrieved from https://www.medicare.gov/coverage/hospice-care
- Centers for Medicare & Medicaid Services. (n.d.). Diagnostic Laboratory Tests. Retrieved from https://www.medicare.gov/coverage/diagnostic-laboratory-tests
- Centers for Medicare & Medicaid Services. (n.d.). Preventive Screening Services. Retrieved from https://www.medicare.gov/coverage/preventive-screening-services
- Centers for Medicare & Medicaid Services. (n.d.). Yearly “Wellness” Visits. Retrieved from https://www.medicare.gov/coverage/yearly-wellness-visits