What do the different parts of Medicare cover?

In general, Part A covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
  • Hospice care
  • Home health care


 Part B covers 2 types of services:

Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.  You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

  1. Abdominal aortic aneurysm screening
  2. Alcohol misuse screenings and counseling
  3. Bone mass measurements (bone density)
  4. Cardiovascular disease screenings
  5. Cardiovascular disease (behavioral therapy)
  6. Cervical & vaginal cancer screening
  7. Colorectal cancer screening
  8. Multi-target stool
  9. DNA tests
  10. Screening barium enemas
  11. Screening colonoscopies
  12. Screening fecal occult blood tests
  13. Screening flexible sigmoidoscopies
  14. Depression screenings
  15. Diabetes screenings
  16. Diabetes self-management training
  17. Flu shots
  18. Glaucoma test
  19. Hepatitis B shots
  20. Hepatitis B virus (HBV) infection screening
  21. Hepatitis C screening test
  22. HIV screening
  23. Lung cancer screening
  24. Mammograms (screening)
  25. Nutrition therapy services
  26. Obesity screenings and counseling
  27. One-time “Welcome to Medicare” preventive visit
  28. Pneumococcal shots
  29. Prostate cancer screenings
  30. Sexually transmitted infections screening and counseling
  31. Tobacco use cessation counseling
  32. Yearly “wellness” visit

Shots:
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots

Part B covers things like:  Clinical research, ambulance services, durable medical equipment (DME), mental health inpatient, outpatient partial hospitalization, limited outpatient prescription drugs

Part D covers all prescription drug medications:

All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes, “like drugs to treat cancer or HIV/AIDS.  Many Medicare drug plans and Medicare health plans with drug coverage place drugs into different levels called “tiers” on their formularies (drug list).  Drugs in each tier have a different cost.  For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.

What DOESN'T Medicare Cover?

Medicare doesn’t cover everything.  Some of the items and services Medicare doesn’t cover include:
  • Long-term care (also called custodial care)
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care