Medicare · Coverage answers

Does Medicare cover it?

Type what you need. We check each answer against the official Medicare rule. Each one shows which part pays and what you would pay.

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Covered
Covered, with conditions
Not covered
14 answers so far

Most asked

Hearing aidsOriginal Medicare does not cover hearing aids or the exams used to fit them. Part B pays for diagnostic hearing tests a physician orders, and since January 2023 beneficiaries may visit an audiologist once every 12 months without a referral for certain non-acute assessments. Some Medicare Advantage plans include a hearing benefit, but terms and any allowance vary by plan.
GLP-1 weight loss drugsMedicare GLP-1 Bridge details: Wegovy, Zepbound KwikPen, and Foundayo for $50 a month through December 31, 2027. Who qualifies and how to get it.
DentalOriginal Medicare does not cover routine dental care like cleanings, fillings, or dentures. What the narrow medical exceptions are, where dental coverage can come from, and how to plan for the cost.
Home health careMedicare covers skilled nursing care, therapy, and related services in your home with no copayment when your doctor certifies you are homebound and orders the care. Personal care and custodial services alone do not qualify. Coverage is available through Part A or Part B depending on your situation.
Cataract surgeryYes, Medicare covers cataract surgery when it is medically necessary. Part B pays for the outpatient procedure at 20 percent coinsurance after the $283 deductible, and Medicare even covers one pair of glasses or contacts afterward.
Long-term careMedicare does not cover long-term custodial care, the daily help someone may need for years. What it does cover (skilled nursing, home health, hospice), the skilled-vs-custodial line, and who pays: out of pocket, Medicaid, or LTC insurance.
Eye examsOriginal Medicare does not cover routine eye exams for glasses, but it does cover medical eye exams for conditions like glaucoma, diabetic retinopathy, and macular degeneration. What you pay, and how Advantage adds routine vision.
Assisted livingMedicare does not pay the room, board, or personal care of assisted living, but it still covers your doctors, hospital stays, and drugs while you live there. Who actually pays: out of pocket, Medicaid, long-term care insurance, or VA benefits.
Physical therapyYes, Medicare covers medically necessary physical therapy. Part B pays for outpatient therapy at 20 percent coinsurance after the deductible, Part A covers it during a hospital or skilled nursing stay, and the old therapy cap is gone.

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Vision, dental and hearing

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GLP-1 weight loss drugs

Every answer, A to Z

A

Assisted livingMedicare does not pay the room, board, or personal care of assisted living, but it still covers your doctors, hospital stays, and drugs while you live there. Who actually pays: out of pocket, Medicaid, long-term care insurance, or VA benefits.

C

D

E

Eye examsOriginal Medicare does not cover routine eye exams for glasses, but it does cover medical eye exams for conditions like glaucoma, diabetic retinopathy, and macular degeneration. What you pay, and how Advantage adds routine vision.

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L

Long-term careMedicare does not cover long-term custodial care, the daily help someone may need for years. What it does cover (skilled nursing, home health, hospice), the skilled-vs-custodial line, and who pays: out of pocket, Medicaid, or LTC insurance.

P

Physical therapyYes, Medicare covers medically necessary physical therapy. Part B pays for outpatient therapy at 20 percent coinsurance after the deductible, Part A covers it during a hospital or skilled nursing stay, and the old therapy cap is gone.

R

Referrals to a specialist· Original Medicare: no referral neededIn most cases, no. With Original Medicare , you can see any specialist who takes Medicare without a referral. Medicare Advantage HMO plans usually require one; PPO plans do not.

Common questions about what Medicare covers

What does Original Medicare not cover?

Original Medicare (Part A and Part B) does not cover everything. Here is what Medicare's own list says it does not pay for:

Most dental care
Eye exams for glasses
Hearing aids and the exams to fit them
Long-term care that is not medical, like help with bathing and dressing
Cosmetic surgery
Massage therapy
Routine physical exams
Concierge care
Care from a doctor who has opted out of Medicare, unless it is an emergency or urgent need

A Medicare Advantage plan may cover some of these as extra benefits.

How can I tell if Medicare will pay for something?

Check three things. First, a doctor must say you need it, and many items need a written order. Second, a Medicare rule must list it as covered. Third, the doctor or supplier must take Medicare. Each answer on this page shows the rule we checked, which part pays, and what you would pay. If you have a Medicare Advantage plan, ask the plan too, because it may need to approve the item first.

What do "Covered," "Covered, with conditions," and "Not covered" mean?

Covered means Medicare pays its share when your doctor says you need it. Covered, with conditions means Medicare pays only if you meet set rules, like a certain diagnosis, a form from your doctor, or a test result. Not covered means Original Medicare does not pay. A few items have narrow exceptions, and each answer explains them.

Does Medicare Advantage cover more than Original Medicare?

Sometimes. A Medicare Advantage plan must cover the same care as Original Medicare. The one exception is hospice, which Original Medicare still pays for. Many plans add extras, like dental care, eye exams, hearing aids, or a gym. Each plan adds different things and pays different amounts. To see what yours covers, read its Evidence of Coverage.