Top 10 Services Covered by Medicare (And a Few That Aren’t)

When it comes to Medicare, one of the first questions beneficiaries ask is, “Does Medicare cover…?” The answer isn’t always straightforward.

Medicare is designed to provide comprehensive coverage for many essential services but also has some gaps. Here’s a closer look at ten key services Medicare covers—and a few that it doesn’t—to help you better understand what to expect from your Medicare plan.

Covered Services: The Top 10 Essentials

1. Hospital Care (Part A)
   Medicare Part A helps cover inpatient stays, including semi-private rooms, meals, nursing care, and other services if admitted to the hospital. Part A also covers care in a skilled nursing facility (SNF) following a qualifying hospital stay. For each benefit period, you’re responsible for a deductible, after which Part A covers most of your hospital costs for up to 60 days.
2. Doctor Visits and Outpatient Care (Part B)
   Part B covers medically necessary services like doctor visits, outpatient procedures, and other specialist care. This includes everything from annual check-ups to outpatient surgeries. You’ll typically pay a monthly Part B premium, an annual deductible, and 20% of the Medicare-approved amount for most services.
3. Preventive Services (Part B)
   Medicare provides a range of preventive services to help detect and prevent illness, including screenings for cancer, diabetes, cardiovascular conditions, and more. Part B also covers an Annual Wellness Visit, which helps you create or update a personalized prevention plan. These services are usually free if you see a provider who accepts Medicare.
4. Mental Health Services (Part A and Part B)
   Medicare covers both inpatient and outpatient mental health care. For inpatient psychiatric care, Part A covers up to 190 days in a lifetime. Outpatient mental health services, such as therapy and counseling, are covered under Part B. This includes services from psychiatrists, clinical psychologists, and social workers.
5. Home Health Services (Part A and Part B)
   Medicare may cover home health services if your doctor certifies that you need intermittent skilled nursing care, physical therapy, or other therapies at home. Part A covers these services after a qualifying hospital stay, while Part B may cover them without a prior hospitalization. Home health care is typically covered in full for approved services.
6. Lab Tests and Diagnostic Imaging (Part B)
   Medicare covers various lab tests, including blood work, X-rays, MRIs, CT scans, and other diagnostic tests to diagnose or monitor a medical condition. Many of these tests are fully covered by Medicare if they’re medically necessary, although you may need to pay some of the costs.
7. Durable Medical Equipment (DME) (Part B)
   Medicare Part B covers medically necessary durable medical equipment, such as wheelchairs, walkers, oxygen equipment, and hospital beds, when prescribed by a doctor. Medicare generally covers 80% of the approved amount, while you are responsible for the remaining 20%.
8. Physical Therapy and Rehabilitation Services (Part B)
   Part B covers physical therapy, occupational therapy, and speech-language pathology services if they’re deemed medically necessary to treat a condition. This includes rehabilitation after surgery or an injury and therapy to manage chronic conditions. There may be limits on therapy services, but you can get more coverage if your provider documents it as medically necessary.
9. Vaccinations (Part B and Part D)
   Medicare Part B covers important vaccines, such as the flu shot, pneumonia vaccine, and hepatitis B vaccine for at-risk people. Part D covers other vaccines, including the shingles vaccine and additional vaccines recommended for travelers. Preventive vaccines are often covered at no cost by an in-network provider.
10. Prescription Drugs (Part D)
    Prescription drug coverage under Medicare is provided through Part D, which helps cover the cost of a wide range of medications. Part D plans have formularies or lists of covered drugs, so checking that your medications are included when selecting a plan is essential. Note that Part D plans vary widely in terms of cost and coverage for specific drugs.

A Few Things Medicare Doesn’t Cover

Medicare is comprehensive, but there are some common services it doesn’t cover. Here are a few key gaps to keep in mind:

1. Dental Care
   Original Medicare generally does not cover routine dental care, such as cleanings, fillings, or dentures. Some Medicare Advantage plans offer limited dental benefits, but beneficiaries often need to purchase separate dental insurance for full coverage.
2. Vision Care
   Original Medicare doesn’t cover routine eye exams and corrective lenses. However, eye exams for certain medical conditions, like glaucoma and macular degeneration, may be covered under Part B. Many Medicare Advantage plans offer some vision coverage.
3. Hearing Aids
   Original Medicare doesn’t cover hearing aids or exams for fitting them. Hearing coverage varies among Medicare Advantage plans, so it’s worth exploring options if this is a concern.
4. Long-Term Custodial Care
   Medicare covers short-term stays in skilled nursing facilities after a qualifying hospital stay, but it does not cover long-term custodial care in nursing homes or assisted living facilities. Medicaid or private long-term care insurance may help cover these costs.
5. Alternative Treatments
   Medicare doesn’t generally cover treatments like acupuncture or chiropractic care beyond limited spinal manipulation or alternative therapies. Some Medicare Advantage plans may cover acupuncture for specific conditions, so check your plan.

What Can You Do About Services That Aren’t Covered?

While Original Medicare has gaps, there are ways to manage these costs:

• Medicare Advantage (Part C) Plans: Many Advantage plans offer limited coverage for dental, vision, and hearing services, and some plans may cover specific alternative treatments. When reviewing Medicare Advantage plans, consider your need for these additional benefits.
• Medigap Policies: Medigap (Medicare Supplement) policies don’t add coverage for excluded services, but they can help cover out-of-pocket costs for covered services. If you’re sticking with Original Medicare, a Medigap policy can help reduce expenses.
• Stand-Alone Insurance: To cover gaps, you can buy stand-alone dental, vision, and hearing insurance. These plans vary widely in price and coverage but are an option if you need routine care in these areas.
• State Programs and Assistance: Some states have programs that help cover certain services for low-income beneficiaries. Medicaid may cover long-term care costs for those who qualify.

Final Thoughts

Understanding what Medicare does—and doesn’t—can help you avoid surprises and plan for your healthcare expenses. Medicare provides a strong coverage foundation for hospital care, doctor visits, preventive services, and more, but it’s essential to be aware of the gaps. Knowing your options can empower you to make the best choices for your healthcare needs and find ways to cover the services Medicare leaves out.