In order for a health care service to be covered by Medicare Part A or Part B, it must be deemed medically necessary. “Medically necessary” is defined as health care services or supplies that are necessary to prevent, diagnose, or treat an illness, injury, condition, disease, or their symptoms within accepted standards of medicine.
In other words, medically necessary services consist of health care that is necessary to keep you healthy.
Procedures, services, supplies, equipment and medications that are designed to treat the following are generally not considered medically necessary and therefore are not covered by Original Medicare:
Additional services that are not considered to be medically necessary include:
Medicare also includes a number of preventive health measures.
Although the following services and products may not seem medically necessary, they are covered by Medicare (certain restrictions are required for some services):
For more information about what Medicare does and does not cover, consult the Centers for Medicare & Medicaid Services’ Items and Services That Are Not Covered Under the Medicare Program or use the Medicare.gov Medicare coverage search tool.
Medicare Advantage plans cover everything Original Medicare covers, and some Medicare Advantage plans may also offer additional benefits such as prescription drug coverage, which Original Medicare doesn’t cover.
To learn more about Medicare Advantage plans where you live and the services they may cover – whether they are medically necessary or not – speak with a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.
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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
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