If you’re unsure or confused about what Medicare covers, you’re not alone. This is one of the most common questions we hear from our patients. That’s why we want to provide more information about the services that Medicare typically covers, as well as what it doesn’t cover.
Medicare coverage isn’t always straightforward — coverage varies depending on whether you choose the Original Medicare Plan or a Medicare Advantage Plan. Below you’ll find some information that we hope will limit the guesswork and help you determine which plans are best for you.
What Does Medicare Cover?
Original Medicare includes two parts — Part A and Part B. In some cases, the services that are covered may depend on where you live. But in general, Medicare will cover most essential medical care.
Medicare Part A covers:
- Home health care
- Hospice care (under certain medical conditions)
- Hospital inpatient care
- Nursing home care if it is inpatient care in a skilled nursing facility that’s not long-term care
- Skilled nursing facility care
Medicare Part B covers:
- Ambulance services
- Clinical trials
- Durable medical equipment (DME), including crutches, walkers, wheelchairs, blood sugar monitors, and oxygen equipment
- Limited outpatient prescription drugs
- Mental health services
- Urgent care
What’s Not Covered by Medicare?
It’s important to know that Medicare doesn’t cover every medical cost, and coverage varies by state. That’s why it’s essential always to double-check what your Medicare plan covers. Medicare.gov offers this list of services that are covered no matter where you live.
In general, Medicare doesn’t cover:
- Cosmetic surgery
- Elective surgery that isn’t considered medically necessary
- Eye exams for prescribing glasses
- Hearing aids and fitting exams
- Most dental care
- Routine foot care
Medicare also doesn’t cover most prescription drugs. You can use a Medicare Advantage Plan to cover prescriptions or purchase a standalone prescription drug plan, called Medicare Part D. These prescription drug plans are usually offered through private companies.
What Do Medicare Advantage Plans Cover?
Keep in mind that all Medicare Advantage Plans (also called Medicare Part C) cover all the services currently offered as part of the Original Medicare Plan. This includes coverage for hospice care, some clinical research studies, emergency care, and urgent care.
But Medicare Advantage Plans offer additional coverage for care that is not part of the Original Medicare Plan. Generally, Medicare Advantage Plans cover:
- Fitness programs (gym memberships)
- Over-the-counter medicine
- Prescription medicine
- Routine hearing exams, hearing aids and fittings
- Transportation to doctor appointments
Keep in mind that each Medicare Advantage Plan is different and can choose to cover only medically necessary services. This means if a service isn’t required to diagnose or treat your condition, you may pay out-of-pocket for those services.
If you still have questions about Medicare, we’re ready to help. Please call us at 305.541.5366 to schedule an appointment or learn more about the Medicare plans offered through LEON Health.