Medicare Coverage

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). The different parts of Medicare help cover specific services.

What does medicare cover?

Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.  Medicare consists of two (2) different parts to help cover specific services, Medicare Part A includes hospital insurance coverage and Medicare Part B which provides medical insurance coverage.  The following information describes what is generally covered by Medicare Parts A and B.

Medicare Part A covers:

  • hospital care
  • Skilled nursing facility care
  • Nursing home care (as long as custodial care isn't the only care you need)
  • Hospice
  • Home health services

Medicare 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.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

Part B covers things like:

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Outpatient Mental health
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

In addition to Medicare Parts A and B, Medicare helps cover specific services listed below:

Medicare Part C (Medicare Advantage Plans)

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.


Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.  

Always talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that's usually covered and your provider thinks that Medicare won't cover it in your situation, you'll have to read and sign a notice saying that you may have to pay for the item, service, or supply.

Find out if Medicare covers your item, service, or supply.

Not sure what kind of coverage you have?

  1. Check your red, white, and blue Medicare card
  2. Check all other insurance cards that you use. Call the phone number on the cards to get more information about the coverage.
  3. Check your Medicare health or drug plan enrollment.

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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