What does, and doesn’t, Medicare cover?

When it comes to Medicare, the question we hear most often after “What does it cost?” is, “What does it cover?”

There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage.

Does Medicare cover prescriptions?

Original Medicare does not include coverage for prescription drugs, but you can buy a stand-alone prescription drug plan to help manage your drug costs. Prescription drug plans—called Medicare Part D—are only available through private companies like Humana. Premiums, and the list of covered drugs—called a formulary—will vary by plan.

Many Medicare Advantage plans include prescription drug coverage, in addition to all the benefits provided by Original Medicare Part A and Part B. Many offer affordable or even $0 monthly premiums, but you must continue to pay the Medicare Part B premium.

An important note: If you want coverage for prescription drugs, you must sign up as soon as you’re eligible, unless you have what’s called “creditable” prescription drug coverage elsewhere. For example, if you’re still working and covered by your employer or your spouse's employer sponsored health coverage, you may be able to wait.

Does Medicare cover nursing homes and long-term care facilities?

Medicare generally doesn’t cover the cost of a nursing home, assisted living or long-term care facility. Medicare Part A does cover care provided in a skilled nursing facility with certain conditions and time limitations.

If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. You may need to exhaust your personal resources on medical care before you are eligible.

Does Medicare cover hearing care?

Medicare Part B may cover diagnostic hearing and balance exams—tests your doctor requires if you need medical treatment. However, Medicare doesn’t cover routine hearing exams, hearing aids or fittings.

Many Medicare Advantage plans, however, do include coverage for routine dental, vision and hearing care, including glasses and hearing aids.

Does Medicare cover hospice?

Medicare covers hospice care if the following conditions are met:

  • Your doctor certifies that you are terminally ill, meaning that your life expectancy is 6 months or less.
  • You consent to receiving palliative care to make you comfortable versus care to try to cure your illness.
  • You sign a consent form to receive hospice care instead of other Medicare-covered treatments for your terminal condition.1

Does Medicare cover home health?

Medicare does help cover some in-home health services including:

  • Skilled nursing care
  • Physical therapy
  • Speech pathology
  • Occupational therapy

To qualify, you must be under the care of a doctor and be treated under a plan of care that is monitored and reviewed by your doctor. Also, your doctor will need to certify that you need certain eligible in-home services.

Medicare will not pay for 24-hour in-home care or meals delivered to you at home. It also doesn’t cover help for what’s called “activities of daily living,” like bathing, getting dressed, using the toilet, eating or moving from place to place within your home.

Does Medicare cover medical devices?

Medicare Part B (medical insurance) helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. Your copays and deductibles will still apply.

There is a long list of items covered, including:

  • Crutches
  • Walkers
  • Wheelchairs
  • Blood sugar monitors and test strips
  • Commode chairs
  • Infusion pumps and supplies
  • Oxygen equipment and supplies

Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. Medicare will only provide coverage through suppliers who participate in the Medicare program.

Does Medicare cover elective procedures?

Services that are not considered medically necessary are generally not covered by Medicare Part A or Part B. For example, breast augmentation for cosmetic reasons isn’t covered by Medicare, but reconstructive surgery after a mastectomy is covered.

Medicare won’t cover Lasik surgery just to avoid the need for glasses. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.

Always err on the side of caution! Confirm your coverage before you commit to a procedure you’re unsure of.

The bottom line

Know your options. Do your homework. Take some time to understand your Medicare plan.

Remember that Medicare Advantage plans are required by law to offer all the benefits of Original Medicare, but most plans offer much more.

Knowing which types of common medical costs are not covered will be helpful when planning for your out-of-pocket medical costs.

Source

  1. “Hospice care,” Medicare.gov, last accessed August 19, 2019, https://www.medicare.gov/coverage/hospice-care, opens new window.

Call a licensed Humana sales agent

1 - 888 - 204 - 4062 (TTY: 711)

Humana answers your Medicare questions

How can we help?

Call us

Licensed Humana sales agents are available daily,
5 a.m. to 8 p.m., local time.

1-888-371-9538 (TTY: 711)

See plans in your area

Enter your ZIP code below to see plans with their premiums, copays, and participating doctors and pharmacies.

ZIP code Please enter ZIP Enter a valid ZIP code

Meet with us

Our licensed Humana sales agents are available to help you review your options, so you can select the coverage that best meets your needs.