Medicare-Covered Treatments and Health Conditions
Medicare covers a range of treatments for different health conditions, including diabetes, arthritis and high blood pressure. Part A will cover treatments you receive as an inpatient while Part B covers outpatient care. For most of the treatments you receive under Part B, you will pay for 20% of the cost after you meet your deductible.
Common Treatments Covered Under Medicare
Medicare generally covers treatments and services that are medically necessary. That means beneficiaries typically qualify for treatment of common conditions that older Americans face.
- Rheumatoid arthritis
- High blood pressure (hypertension)
- Respiratory disease
- Alzheimer’s disease
Part B typically covers treatments in outpatient care. If you are an inpatient or hospitalized, then Part A covers your treatment. The same treatments are covered by Medicare Advantage plans, which are sold through private insurers, since they must include everything covered under Original Medicare at minimum.
Medicare Coverage of Diabetes
Medicare does cover some supplies, services and treatments that relate to the management of diabetes. This includes things like insulin pumps and blood sugar or glucose testing monitors.
- Diabetes screenings
- Diabetes prevention program
- Diabetes equipment and supplies
- Insulin pumps
One key area related to diabetes that is not covered by Original Medicare is insulin, which is typically only available through a Part D prescription drug plan. Original Medicare also will not cover syringes or needles.
As with other treatments Medicare covers, you typically will pay 20% of the cost after you have met your deductible.
Cancer Treatments Covered Under Medicare
Medicare will cover many different treatments related to cancer. Under Part A, cancer treatments you receive as an inpatient are covered, as well as home health care and hospice care.
Under Part B, chemotherapy drugs and outpatient treatment are typically covered. Radiation treatments, outpatient surgeries and equipment are also covered.
- Radiation treatment
- Diagnostic tests
- Doctor’s visits
- Durable medical equipment
- Inpatient care
- Home health care
There are some treatments and services related to having cancer that Medicare also covers. These treatments include screenings and diagnostic tests, as well as mental health services and breast prostheses after a mastectomy.
Surgical Procedures Approved by Medicare
Medicare covers surgeries that are medically necessary. Part A will cover surgeries if you’re hospitalized as an inpatient, whereas Part B will cover outpatient surgeries. As with other Part B costs, you will pay 20% after you have met your deductible.
- Heart surgery
- Broken bone repair
- Wound debridement
- Hip or knee replacement
Medicare does not cover cosmetic surgeries, elective surgeries or procedures that don’t have medical value.
Neurological Disorders Medicare Coverage
Neurological disorders can take many forms, but some of the most common types older Americans face are Parkinson’s and Alzheimer’s.
According to the U.S. Centers for Disease Control and Prevention, nearly six million Americans have Alzheimer’s alone.
Medicare can pay for some cost of care associated with Alzheimer’s, like hospital stays through Part A or hospice care. But long-term care or a permanent move to a nursing home is not covered.
There is also no cure for Alzheimer’s, and treatments in general are limited.
Medicare can also cover areas associated with Parkinson’s, including physical therapy and speech therapy. Services like physical therapy are typically covered in any setting, from inpatient to within your home.
Cardiovascular Treatments Covered Under Medicare
Medicare will cover treatments associated with cardiovascular issues and heart disease.
- Behavioral therapy
- Cardiac rehabilitation
- Some medications
- Doctor’s visits
Behavioral therapy that Medicare covers includes an annual discussion with your doctor to lower your risk of cardiovascular disease, a blood pressure check and tips on how to eat well.
Cardiac rehabilitation can help you get your heart health back on track after an event like a heart attack.
Both Parts A and B will cover different areas of your cardiovascular health depending on the specific type of treatment you are receiving.
Medicare Coverage of Respiratory Procedures
Medicare covers several different types of respiratory procedures. One major area of coverage is pulmonary rehabilitation.
Pulmonary rehabilitation programs are covered for beneficiaries who have moderate or worse chronic obstructive pulmonary disease (COPD). The programs include exercise, education and treatment plans to help you recover from your condition.
Medicare will cover several other areas related to COPD as well, including treatments, oxygen and some medication.
- Pulmonary rehabilitation programs
- Oxygen and oxygen equipment
- Some medications
Medicare may also cover oxygen equipment as a type of durable medical equipment.
Medicare-Approved Mental Health Treatments
Medicare offers coverage for a range of treatments and services related to mental health. Under Part A, beneficiaries are covered for mental health treatment that they receive while hospitalized as an inpatient.
Many types of outpatient mental health treatments are covered through Part B. This can include everything from family counseling to a psychiatric evaluation.
Most prescription drugs for mental health treatment are not covered under Original Medicare. You will need a Part D prescription drug plan to cover antidepressants and other prescribed drugs in relation to your mental health.
Pain Management Therapies Approved by Medicare
Original Medicare can cover a range of pain management therapies and treatments. Pain management is an all-encompassing term that can refer to a variety of options to manage discomfort. Medicare covers many of these treatments.
- Medication management
- Physical therapy
- Occupational therapy
- Acupuncture for lower chronic back pain
Medicare Part B will cover 80% of the cost for pain management therapies and treatments. Pain management through prescription drugs is typically only covered through a Part D plan. Original Medicare rarely covers prescription drugs.
6 Cited Research Articles
- Alzheimer’s Association. (n.d.). Medicare. Retrieved from https://www.alz.org/help-support/caregiving/financial-legal-planning/medicare
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Coverage of Cancer Treatment Services. Retrieved from https://www.medicare.gov/Pubs/pdf/11931-Cancer-Treatment-Services.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Pain Management. Retrieved from https://www.medicare.gov/coverage/pain-management
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Surgery. Retrieved from https://www.medicare.gov/coverage/surgery
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What Medicare Covers. Retrieved from https://www.medicare.gov/what-medicare-covers
- U.S. Centers for Medicare & Medicaid Services. (n.d.). What Part B Covers. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-b-covers