What Types of Medical Procedures Does Medicare Cover?

Medicare covers numerous types of medical services and procedures. Before they will cover it, however, the service or procedure must be deemed medically necessary by your physician. People in the hospital, home health care or nursing home will have their needs covered by Medicare Part A coverage. For people outside of those settings, Medicare Part B covers medical services and procedures. Samples of the types of medical services and procedures that are covered by Medicare include:

• Ambulance Services
• Approved Dental Surgery Related to a Covered Procedure
• Approved Home Health Care
• Cardiovascular Screening and Cardiac Rehabilitation Programs
• Diabetes Screening
• Diabetic Foot Exams
• Emergency Room Visits
• Mammogram Screening
• Oxygen Therapy
• Skilled Nursing Facility Care
• Vaccinations

Many other services and procedures may be covered if they can be shown to be medically necessary and your doctor has documented it in your medical records.

Examples of items that are not covered by Medicare are:

• Alternative Therapy
• Hearing Exams and Aids
• Routine Physical Exams
• Routine Dental Services
• Travel Coverage


What Will Be My Cost for Services and Procedures?



How much you will pay for medical services and procedures will depend on whether or not you have Medicare Part B coverage, and from whom you receive your services and procedures. However, in general, if you are enrolled in Medicare Part B:

...And you have met your yearly deductible and do not have any secondary insurance, you will pay 20% of the approved Medicare amount.

...And you receive Medicare through a Medicare Advantage Health Plan, you owe little to nothing depending on the plan that you are signed up with and the benefits of the plan. It is important to research the different plans available in your area so that you have the coverage that best meets your needs.

Review your plan’s coverage or call your plan’s customer service to learn about the factors that may affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you receive your services and procedures through an approved doctor, health care provider, or supplier that accepts assignment.