What is Covered?

Medicare Part B covers up to 12 acupuncture visits in 90 days, but only for chronic low back pain. You can potentially received an additional 8 sessions if you show improvement. If your doctor decides your chronic low back pain isn’t improving or is getting worse, then Medicare won't cover your additional treatments. No more than 20 acupuncture treatments can be given per year.

Medicare Part B covers medically necessary allergy tests (such as skin, blood and food testing) when prescribed by Medicare-approved physicians. Allergy shots, or allergen immunotherapy, are sometimes covered by Medicare or Medicare Advantage.

If a doctor certifies that blood work and/or lab tests are medically necessary, they would be covered by Medicare Part B. This coverage may vary based on your geographic location.

Once you've met your deductible, you'll have to pay a 20% copayment for cardiac rehabilitation. Medicare Part B covers cardiac rehab if you've had at least one of the following conditions:

• A heart attack in the last 12 months
• Coronary artery bypass surgery
• Current stable angina (chest pain)
• A heart valve repair or replacement
• A coronary angioplasty (a medical procedure used to open a blocked artery) or coronary stent (a procedure used to keep an artery open)
• A heart or heart-lung transplant
• Stable chronic heart failure

Medicare does not typically cover all of the costs associated with Cataract Surgery. It can cover part of the surgery and corrective lenses after the surgery after your Part B deductible.

You pay a copayment for hospital outpatient chemotherapy covered under Part B. For chemotherapy given in a doctor's office or clinic, you will have to pay 20% of the Medicare-Approved Amount, as well as the Part B deductible. Many people may choose to add Medicare Supplement Insurance (Medigap) or switch to Medicare Advantage to help cover the high out-of-pocket costs associated with cancer treatment.

Medicare Part B covers manual manipulation of the spine by a chiropractor or other qualified provider if deemed medically necessary to correct a subluxation (when one or more of the bones of your spine move out of position). You will be responsible for paying 20% of the Medicare-Approved Amount and the Part B deductible. Medicare doesn't cover other services or tests a chiropractor orders, including X-rays, massage therapy, and acupuncture.

Medicare may pay for a health care provider’s help to manage chronic conditions if you have 2 or more serious chronic conditions that are expected to last at least a year. You may pay a monthly fee, and the Part B deductible and coinsurance apply. If you have supplemental insurance, or have both Medicare and Medicaid, it may help cover the monthly fee.

Unless your dermatology care is considered medically necessary, Medicare Part A and Part B won't cover dermatology. While Medicare does not cover annual skin checks, if you or your doctor discover something that needs further evaluation, Medicare would cover that.

You are eligible for Medicare before you turn 65 if you have end-stage renal disease, though there may be other eligibility requirements. Medicare covers the cost of dialysis and kidney transplants. You can also sign up for Medicare Advantage plans to cover these costs. There may be additional coinsurance and premium fees.

Medicare Part B covers medically necessary DME if your doctor prescribes it for use in your home. If your supplier works with Medicare, you pay 20% of the Medicare-Approved Amount, and the Part B deductible applies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment. You may be able to rent or buy the equipment. If your doctor or supplier is not enrolled to work with Medicare, Medicare will not pay the claims submitted by them. Some examples of DME that Medicare covers are:

• Blood sugar meters
• Blood sugar test strips
• Canes
• Commode chairs
• Continuous passive motion devices
• Continuous Positive Airway Pressure (CPAP) devices
• Crutches
• Hospital beds
• Home infusion services
• Infusion pumps & supplies
• Lancet devices & lancets
• Nebulizers & nebulizer medications
• Oxygen equipment & accessories
• Patient lifts
• Pressure-reducing support surfaces
• Suction pumps
• Traction equipment
• Walkers
• Wheelchairs & scooters

Original Medicare will typically cover at least a portion of your emergency room visits. Whether Medicare Part A or Part B is what covers the stay depends on if you are admitted or not. If you are admitted at least two nights, Medicare Part A will cover it. If you are not admitted, Medicare Part B kicks in. You pay a copayment for each emergency department visit and a copayment for each hospital service. You also pay 20% of the Medicare-Approved Amount for your doctor's services, and the Part B deductible applies.

Medicare Part B covers E-Visits with your doctors and certain other practitioners. You are responsible for paying 20% of the co-pay and your deductible.

Medicare will cover certain types of genetic testing called Next Generation Sequencing, molecular diagnostic genetic test and PGx. Medicare will also cover cancer genetic tests for acquired or inherited cancer (ie: inherited breast or ovarian cancer, advanced stage III or IV cancer). The tests must be deemed medically necessary and ordered and received by a physician who is FDA approved. It is always best to check with your Medicare coverage provider before any genetic testing is done.

Medicare will only cover certain home health care services. It is best to verify specific services directly with your Medicare coverage provider. You may also read more about Home Health Care coverage on Medicare.gov.

Immunosuppressive Drugs can reduce the risk of organ rejection (some charges covered by Part B) as well as manage autoimmune and inflammatory conditions (some charges covered by Part D). If you have Medicare because you qualify due to End Stage renal disease (ESRD), Medicare Part B will cover the costs of immunosuppressive drugs after you get a kidney transplant. The procedure must take place in a Medicare-approved facility and coverage will end 36 months after you leave the hospital. If you have Medicare due to age or disability, Medicare Part B will cover the costs of these drugs for the rest of your life if: you had an organ transplant, that transplant occurred at a Medicare-approved facility, and you had Part A at the time of the surgery.

You pay 100% for insulin (unless used with an insulin pump, then you pay 20% of the Medicare-Approved Amount, and the Part B deductible). You may be able to get coverage on insulin with a Medicare Part D plan, or a Medicare Advantage plan with drug coverage that participates in the insulin savings model. Participating plans offer a maximum copayment of $35 a month for insulin supplies. These plans can offer coverage choices that include multiple types of insulin at a maximum copayment of $35 for a month's supply.

Since a knee replacement typically requires at least a short hospital stay, you'll want to look at your hospital coverage to understand which part of Medicare may cover this service. Inpatient surgery will be covered by Part A. If the surgery is outpatient, that would be covered by Part B. Neither Part A nor Part B will cover the pain medication necessary after surgery. Medicare Advantage would cover knee replacement surgery plus any rehabilitative services required post-surgery.

Medicare Part A would cover some hospital related costs if mental health treatment is provided as an inpatient. Medicare Part B would cover some preventive checks for mental health issues on an annual basis and some treatments.

Magnetic resonance imaging, or MRI, is covered by Medicare when prescribed by a Medicare-approved doctor and performed at a facility that accepts Medicare assignment. The specific cost will vary based on the type of scan, location, and other treatments needed with your test. Medicare Part A would cover inpatient MRIs, while Part B will help pay for outpatient MRIs. Medicare Advantage may offer at least the same coverage as Original Medicare, but many plans have different payment structures.

Palliative care is specialized medical care for people living with a serious illness. This type of care is covered by Medicare. Which part of Medicare covers each service depends on the specific service.

Medicare Part A and Part B do not typically coverage over-the-counter prescription drugs. You can add Medicare Part D through a private insurance company to get prescription drug coverage. Part D plans can vary by state so it is important to know if your particular prescription drug is covered in your plan. Medicare Part B covers a limited number of outpatient prescription drugs under limited conditions. To learn more about Medicare Prescription Drug coverage, visit Medicare.gov.

Medicare Part B typically covers the following preventative services and screenings:

• Abdominal aortic aneurysm screening
• Alcohol misuse screenings & counseling
• Bone mass measurements (bone density)
• Cardiovascular disease screenings
• Cardiovascular disease (behavioral therapy)
• Cervical & vaginal cancer screening
• Colorectal cancer screenings
  • Multi-target stool DNA tests
  • Screening barium enemas
  • Screening colonoscopies
  • Screening fecal occult blood tests
  • Screening flexible sigmoidoscopies
• Depression screenings
• Diabetes screenings
• Diabetes self-management training
• Flu shots
• Glaucoma tests
• Hepatitis B shots
• Hepatitis B Virus (HBV) infection screening
• Hepatitis C screening test
• HIV screening
• Lung cancer screening
• Mammograms (screening)
• Nutrition therapy services
• Obesity screenings & counseling
• One-time “Welcome to Medicare” preventive visit
• Pneumococcal shots
• Prostate cancer screenings
• Sexually transmitted infections screening & counseling
• Shots:
  • COVID-19 vaccines
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
• Tobacco use cessation counseling
• Yearly "Wellness" visit

Medicare Part B will cover a second opinion on surgery by a doctor who accepts Medicare in some cases for medically necessary, non-emergency surgery. Medicare will also help pay for a third opinion if the first and second are different. You will be responsible for paying the 20% copayment and the Medicare Part B deductible applies.

After your deductible is met, Original Medicare will pay for 80% of the medically necessary surgeries. You will be responsible for the remaining 20% of the costs. Part A covers inpatient surgeries while Part B covers outpatient operations.

Medicare Part B covers certain telehealth services. You pay a 20% copayment and the Part B deductible.

Medicare covers several types of therapy, including but not limited to mental health, physical therapy, occupational therapy, speech therapy and behavioral therapy. You are responsible for a 20% copayment as well as the Medicare Part B deductible.

Medicare covers emergency transportation if it’s medically necessary or reduces further health risk. You are responsible for a 20% copayment as well the Medicare Part B deductible. In some cases, Medicare may pay for limited, medically necessary, nonemergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is medically necessary. For example, someone with End-Stage Renal Disease may need medically necessary ambulance transport to a facility that furnishes renal dialysis.

Medicare Part B covers urgent care needed to treat a sudden illness or injury that isn't something you would go to the emergency room for. You are responsible for a 20% copayment as well the Medicare Part B deductible.

A variety of vaccines can be covered by Medicare. It is always best to confirm with your doctor prior to receiving an immunization or vaccine. Here are some examples of vaccine coverage:

• Flu Shots - Medicare Part B covers an annual flu shot.
• Hepatitis A Vaccine - only covered by Medicare Part B if given in an inpatient environment. Part D should cover the Hepatitis A vaccine, though you may still need to pay a copayment or coinsurance towards your deductible.
• Hepatitis B Vaccine - Medicare Part B covers the full cost of the Hep B vaccine if you are a medium to high risk of getting it. If you are low risk, Part B will not cover it. Confirm with your doctor what your risk level is. Medicare Advantage plans may cover the cost.
• Pneumonia Shots - pneumonia vaccine(s) are either covered by Medicare Part B or a Medicare Advantage plan.

Medicare Part B covers a "Welcome to Medicare" preventative visit once within the first 12 months you have Part B. You pay nothing for this visit if your doctor or other qualified health care provider accepts Medicare. The Part B deductible does not apply.

Medicare Part B covers medically necessary diagnostic X-rays. You are responsible for a 20% copayment as well the Medicare Part B deductible. If the X-ray is done in a hospital outpatient setting, you pay a copayment.