If you’re age 65 or over and have Medicare, then you probably find yourself wondering what specifically does Medicare cover. Here’s a refresher of some of Medicare’s coverages along with an answer to some other questions regarding Medicare.
What Does Medicare Part A Cover?
Generally speaking, Medicare Part A will cover the following, according to the Medicare website:
- Home health care
- Hospice care
- Inpatient care in a hospital
- Nursing home care
- Skilled nursing facility care
As you may expect, there are lots of nuances. Always double check coverage for your exact situation. Some services may be covered only in patients with certain conditions, for instance.
What Does Medicare Part B Cover?
Medicare Part B typically covers the following:
- Medically necessary services or supplies that are needed to diagnose or treat your medical condition. These services or supplies should meet “accepted standards of medical practice,” according to the Medicare.gov website.
- Preventive services that will prevent illnesses or detect it at an early stage.
Part B coverage typically includes the following:
- Ambulance services
- Clinical research
- Durable medical equipment
- Mental health services
- Limited outpatient prescription drugs
Again, always confirm coverage for your specific medical needs.
So, what does this mean for Medicare coverage for several other items? Here are answers to some of the most frequently asked questions about Medicare.
Does Medicare Cover Eye Exams?
Medicare does NOT cover eye exams for glasses or contact lenses. However, Medicare Part C–also known as Medicare Advantage– will cover additional benefits, including eye exams, that original Medicare does not cover.
If you are having an eye exam for other purposes, you may have some coverage. For instance, if you have diabetes, Medicare Part B will cover an annual exam for diabetic retinopathy. You will pay 20% of the amount for your doctor’s services, and then the Part B deductible applies. Medicare also will cover the cost of a test for glaucoma once a year if you are at higher risk for this common eye condition. Those in the higher risk category include those with diabetes and African Americans who are age 50 or older.
Does Medicare Cover Cataract Surgery?
Yes. Medicare will cover the cost for a pre-surgical exam and cataract surgery. You typically will pay 20% for the coinsurance, and then the Medicare Part B deductible will apply. It also will cover the cost of glasses for after surgery, if you need them. Medicare also covers the cost of a conventional lens implanted in the eye called a monofocal lens. However, cataract surgery has some newer technology available, such as lenses that could make your vision even crisper. You will likely have to pay out of pocket for this newer technology.
Does Medicare Cover Hearing Aids?
No. Medicare Part B does not cover the cost of hearing aids or exams to fit hearing aids. If you have Medicare Part C/Medicare Advantage, it may have some additional benefits, including hearing coverage, that original Medicare does not cover. For other reading, we recommend these tips to choose the best hearing aid.
Does Medicare Cover Dental?
Generally speaking, no. You have to pay for dental care, procedures, cleanings, fillings, dentures, and other dental services. If you are in the hospital and require dental services or emergency or complex dental procedures, then Medicare Part A will pay for some dental services–again, if you are in the hospital.
Does Medicare Cover Acupuncture?
Yes, but for only one condition–chronic low back pain. Medicare Part B will cover the cost of up to 12 acupuncture visits over 90 days and then an additional eight sessions if you are improving. If your doctor decides that your chronic low back pain is not getting better, Medicare will not cover the treatments. Medicare will cover no more than 20 acupuncture treatments over one year.
Medicare defines chronic low back pain as lasting three months or longer, not having a known cause (such as cancer or infectious disease), and not caused by surgery.
Medicare requires that the doctor performing acupuncture have specific credentials. Find out more about those credentials here, from the Medicare.gov website.
Does Medicare Cover Home Health Care?
Yes, Medicare covers home health care for some specific services and criteria. Medicare Part A and/or Part B will cover:
- Part-time skilled nursing care
- Medical social services
- Part-time home health aide services
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Injectable osteoporosis drugs for women
However, Medicare will not cover 24-hour care at your home, meal delivery, shopping/cleaning (if that is the only care you need), or custodial/personal care if that is the only care that you need.
To get these home health care services covered, you must be under the care of a doctor or have a plan of care that is regularly reviewed by a doctor. Other criteria and restrictions apply, which you can find here.
Does Medicare Cover Dentures?
Medicare does not cover dentures. However, Medicare Advantage or Medical Supplemental Insurance plans may cover the cost of dentures. Remember that these plans are available at an additional cost.
Does Medicare Cover Flu Shots?
Yes. Medicare Part B will cover one flu shot per flu season.