Medicare Benefits

If you’re nearing 65 years of age or are younger with a disability or End-Stage Renal disease, you’ve probably heard of Medicare and maybe even started learning about enrollment. The next step is to learn what benefits Medicare covers, which may be confusing to some because there are so many different parts to consider.

Multiple generations of a family at a picnic

The four parts of Medicare

There are two parts to ”Original Medicare” — Part A and Part B — and each part covers a different set of benefits. Generally speaking, Medicare Part A (Hospital Insurance) covers inpatient hospital care, skilled nursing facility care, hospice care, and limited home health care. Medicare Part B (Medical Insurance) covers doctor’s services, surgery, lab tests, durable medical equipment and certain preventive services.

There are other options (such as Part C, Part D and Medicare Supplement Insurance) that offer benefits that Original Medicare does not.

So before you enroll in Medicare, it might help you to know exactly what Original Medicare helps pay for so you can make an informed decision about your Medicare coverage.

What Original Medicare covers

The table below is offered as a reference, but may not be comprehensive. For more specific information relating to each service or supply, visit Medicare.gov’s Medicare Coverage search tool or contact a Medicare representative. 

Service or Supply

Part A

Part B

Abdominal aortic aneurysm screening

 

Acupuncture

   

Alcohol misuse screening and counseling

 

Ambulance services

 

Ambulatory surgical centers

 

Anesthesia

✔ - inpatient

✔ - outpatient

Artificial limbs and eyes

 

Blood

✔ - inpatient

✔ - outpatient

Blood processing and handling

✔ - inpatient

✔ - outpatient

Bone mass measurement

 

Braces (arm, leg, back and neck)

 

Breast prostheses/reconstruction

✔ - inpatient

✔ - outpatient

Canes/crutches

 

Cardiac rehabilitation program

 

Cardiovascular disease behavioral therapy

 

Cardiovascular disease screenings

 

Cervical and vaingal cancer screenings

 

Chemotherapy

✔ - hospital patients

✔ - hospital outpatients and freestanding clinic and doctor’s office patients

Chiropractic services

 

Clinical research studies

Colorectal cancer screening

 

Commode chairs

 

Continuous passive motion (CPM) machine

 

Continuous Positive Airway Pressure (CPAP) therapy

 

✔ - 3-month trial and possibly longer

Concierge care

   

Cosmetic surgery

NO - unless needed because of accidental injury or malformation

NO - unless needed because of accidental injury or malformation

Custodial care

   

Defibrillator

Dental Services

   

Depression Screening

 

Diabetes screenings

 

Diabetes services and supplies

 

Diagnostic tests

 

Dialysis (kidney) services and supplies

✔ - inpatient

✔ - outpatient, training and equipment

Doctor and other health care provider services

 

Durable medical equipment (DME)

 

EKG (electrocardiogram) screening

 

Emergency department services

 

Eye exams

   

Eyeglasses/contact lenses

 

✔ - for corrective lenses after cataract surgery only

Federally qualified health center services

 

Flu shots

 

Foot care

 

Glaucoma tests

 

Health education/wellness programs

   

Hearing and balance/hearing aids

 

✔ - doctor ordered

Hepatitis B shots

 

✔ - if at high or medium risk

Hepatitis C screening test

 

HIV screening

 

Home health services

Hospice care

 

Hospital bed (see “Durable medical equipment”)

   

Humidifiers

   

Hyperbaric oxygen (HBO) therapy

 

Inpatient hospital care

✔ - doctor’s services while you are in hospital

Kidney disease education

 

Laboratory tests (clinical)

 

Lung cancer screening

 

Macular degeneration

 

Mammograms

 

Mental health care

✔ - inpatient

✔ - outpatient

Nursing home care

✔ - for medically necessary skilled care

 

Nutrition therapy services

 

✔ - for services related to diabetes or kidney disease

Obesity screening & counseling

 

✔ - for people with BMIs of 30 or over

Orthotics, artificial limbs, and eyes

 

Ostomy supplies

 

Outpatient hospital services

 

Oxygen equipment and accessories

 

Physical therapy/occupational therapy/speech-language pathology services

 

Pneumococcal shots

 

Prescription drugs (outpatient) limited coverage

 

✔ - limited coverage

Preventive services

 

Preventive visits

 

Prostate cancer screenings

 

Prosthetic devices

 

Pulmonary rehabilitation program

 

Radiation therapy

✔ - inpatient

✔ - outpatient

Religious nonmedical health care institution (RNHCI) items

   

Rural health clinic services

 

Second surgical opinions

 

Sexually transmitted infections screening and counseling

 

Shots

 

✔ - flu, hepatitis B and pneumococcal

Skilled nursing facility (SNF) care

 

Smoking and tobacco-use cessation counseling

 

Supplies (you use at home)

   

Surgical dressing services

 

Telehealth

 

Transplants (doctor services)

 

Transplants (facility charges)

 

Transportation (routine)

   

Travel (healthcare needed outside of U.S.)

   

Urgently needed care

 

Walker/wheelchair

 

X-rays

 

Medicare Part C and Part D

As mentioned before, there are other benefits that aren’t part of Original Medicare.

Medicare Part C (Medicare Advantage plans) allows private insurance companies to sell health insurance plans that offer at least the same benefits as Original Medicare. In many cases, Medicare Advantage plans offer additional coverage as well — like prescription drugs, vision and dental. But like traditional health insurance plans, their cost, coverage areas and benefits vary.

Medicare Part D (prescription drug coverage) adds prescription drug coverage to Medicare. You can either buy a freestanding Prescription Drug Plan to use in conjunction with Original Medicare or a Medicare Advantage plan that doesn’t include drug coverage, or you can buy a Medicare Advantage plan that includes drug coverage (MA-PD plans).

Like Part C, Prescription Drug Plans are offered through private insurance companies.

To learn more about your Medicare options, contact a licensed insurance agent at TTY Users: 711.

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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.

Medicare has neither reviewed nor endorsed this information.