C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S

This official government guide 

has important information 

about the items and services 

Original Medicare covers.

YOURMEDICARE

BENEFITS

2 0 1 9
C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S

Your Medicare Benefits

The information in “Your Medicare Benefits” describes the Medicare Program at 

the time it was printed. Changes may occur after printing. Visit Medicare.gov or call 

1-800-MEDICARE (1-800-633-4227), to get the most current information. TTY 

users can call 1-877-486-2-48. “Your Medicare Benefits” isn’t a legal document.

Official Medicare Program legal guidance is contained in the relevant statutes, 

regulations, and rulings.
3

This booklet describes many, but not all, of the health care items and services covered by Medicare Part A (Hospital Insurance) and Medicare 

Part B (Medical Insurance). It includes information on how and when you can 

get these benefits and how much you’ll pay.

“Your Medicare Benefits” lists many, but not all, of the items and services that 

Original Medicare covers. If you have a question about a test, item, or service 

that isn’t listed in this booklet, visit Medicare.gov or call 1-800-MEDICARE 

(1-800-633-4227). TTY users can call 1-877-486-2048.

If you have a Medicare Advantage Plan (like an HMO or PPO) or other 

Medicare health plan, you have the same basic benefits as people who have 

Original Medicare, but the rules vary by plan. Some services and supplies 

may not be listed because the coverage depends on where you live. For more 

information, contact your plan.

THIS

ABOUT

BOOKLET
4
5

SECTION

1 Before you read 

this booklet

Review the questions and answers below before you read “Your 

Medicare Benefits.” They explain information that will be important in 

understanding Medicare coverage. 

What’s the Part B deductible?

In 2019, you pay a yearly $185 deductible for Part B-covered services 

and supplies before Medicare begins to pay its share, depending on the 

service or supply. 

What’s assignment, and why is it important?

Assignment is an agreement by your doctor, provider, or supplier to 

be paid directly by Medicare, to accept the payment amount Medicare 

approves for the service, and not to bill you for any more than the 

Medicare deductible and coinsurance.

Depending on the service or supply, actual amounts you pay may be 

higher if doctors, other health care providers, or suppliers don’t accept 

assignment. Doctors who don’t accept assignment may charge you 

more than the Medicare-approved amount for a service, but they can’t 

charge more than 15% over the Medicare-approved amount for nonparticipating doctors. This is called the “limiting charge.” The limiting 

charge applies only to certain services and doesn’t apply to some supplies 

and durable medical equipment (DME). When getting certain supplies 

and DME, Medicare will only pay for them from suppliers enrolled in 

Medicare, no matter who submits the claim (you or your supplier). 
6 Section 1: Before you read this booklet

What if my doctor recommends a service more often than Medicare 

covers it?

Your doctor or other health care provider may recommend you get services more 

often than Medicare covers. Or, they may recommend services that Medicare 

doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s 

important to ask questions so you understand why your doctor is recommending 

certain services and whether Medicare will pay for them.

What if I disagree with a coverage or payment decision?

You have the right to appeal. For more information on how to file an appeal, see 

your “Medicare & You” handbook or visit Medicare.gov/appeals.

What if an item or service isn’t listed or I need more information?

Visit Medicare.gov/coverage and type the item or service into the search box for 

more information. Or, you can call 1-800-MEDICARE (1-800-633-4227). 

TTY: 1-877-486-2048.

Preventive services

Preventive services help you stay healthy. There’s a 

picture of an apple next to preventive service that 

Medicare covers. Talk with your doctor about which 

preventive services are right for you.
7

SECTION

Items & services 2

Abdominal aortic aneurysm screenings 

Part B covers an abdominal aortic screening ultrasound if you’re at risk. You’re 

considered at risk if you have a family history of abdominal aortic aneurysms, 

or you’re a man age 65–75 and have smoked at least 100 cigarettes in your 

lifetime. 

How often

Once.

Costs

You pay nothing for this screening if your doctor or other qualified health care 

practitioner accepts assignment.

Things to know

You must get a referral from your doctor or other qualified health care 

practitioner.

More information

Visit Medicare.gov/coverage/abdominal-aortic-aneurysm-screenings.

Acupuncture 

Medicare doesn’t cover acupuncture.

Costs

You pay 100% for non-covered services, including acupuncture. 

More information

Visit Medicare.gov/coverage/acupuncture.
8 Section 2: Items & services

Advance care planning 

Part B covers voluntary advance care planning as part of your yearly “Wellness” visit. 

See “Preventive visits” on pages 82–83. Medicare may also cover this service as part of 

your medical treatment.

Costs

You pay nothing for this planning if your doctor or other qualified health care provider 

accepts assignment and this is provided as part of your yearly “Wellness” visit. If it’s 

provided as part of your medical treatment, the Part B deductible and coinsurance apply.

What it is

Advance care planning is planning for care you would get if you become unable to 

speak for yourself. You can talk about an advance directive with your health care 

professional, and he or she can help you fill out the forms, if you want to. An advance 

directive is an important legal document that records your wishes about medical 

treatment at a future time, if you’re not able to make decisions about your care. 

Things to know

For help with advance directives, visit the Eldercare Locator at eldercare.acl.gov. 

More information

Visit Medicare.gov/coverage/advance-care-planning.

Air-fluidized beds & other support surfaces 

Part B covers air-fluidized beds and other support surfaces as durable medical 

equipment (DME) that your doctor prescribes for use in your home.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/air-fluidized-beds. 
Section 2: Items & services 9

Alcohol misuse screenings & counseling 

Part B covers an alcohol misuse screening if you’re an adult (including pregnant 

women) who uses alcohol, but you don’t meet the medical criteria for alcohol 

dependency. If your primary care doctor or other primary care practitioner 

determines you’re misusing alcohol, you can get up to 4 brief face-to-face 

counseling sessions per year (if you’re competent and alert during counseling).

How often

Once per year. 

Costs

You pay nothing if your qualified primary care doctor or other primary care 

practitioner accepts assignment. 

Things to know

A qualified primary care doctor or other primary care practitioner must provide 

the counseling in a primary care setting (like a doctor’s office). 

More information

Visit Medicare.gov/coverage/alcohol-misuse-screenings-counseling.

Ambulance services 

Part B covers ground ambulance transportation when you need to be transported 

to a hospital, critical access hospital, or skilled nursing facility for medically 

necessary services, and transportation in any other vehicle could endanger 

your health. Medicare may pay for emergency ambulance transportation in an 

airplane or helicopter to a hospital if you need immediate and rapid ambulance 

transportation that ground transportation can’t provide.

In some cases, Medicare may pay for limited, medically necessary, non-emergency 

ambulance transportation if you have a written order from your doctor stating that 

ambulance transportation is medically necessary. For example, you may need a 

medically necessary ambulance transport to a dialysis facility if you have End-Stage 

Renal Disease (ESRD).
10 Section 2: Items & services

Ambulance services (continued) 

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Things to know

Medicare will only cover ambulance services to the nearest appropriate medical 

facility that’s able to give you the care you need. 

More information

• Visit Medicare.gov/coverage/ambulance-services.

• Visit Medicare.gov/publications to download and read the booklet “Medicare 

Coverage of Ambulance Services.”

Ambulatory surgical centers 

Part B covers the facility service fees related to approved surgical procedures 

provided in an ambulatory surgical center (facility where surgical procedures are 

performed, and you’re expected to be released within 24 hours). 

Costs

You pay the Part B deductible and 20% of the Medicare-approved amount to both 

the ambulatory surgical center and the doctor who treats you. You pay nothing 

for certain preventive services if the doctor or other health care provider accepts 

assignment. You pay all facility service fees for procedures Medicare doesn’t cover in 

ambulatory surgical centers. 

More information

Visit Medicare.gov/coverage/ambulatory-surgical-centers.
Section 2: Items & services 11

Anesthesia 

Part A covers anesthesia services provided by a hospital if you’re an inpatient. 

Part B covers anesthesia services provided by a hospital if you’re an outpatient or by 

a freestanding ambulatory surgical center if you’re a patient. 

Costs

You pay 20% of the Medicare-approved amount for the anesthesia services provided 

by a doctor or certified registered nurse anesthetist, and the Part B deductible 

applies. The anesthesia service must be associated with the underlying medical or 

surgical service, and you may have to pay an additional copayment to the facility. 

More information

Visit Medicare.gov/coverage/anesthesia.

Artificial eyes & limbs 

Part B covers medically necessary artificial eyes and limbs when your doctor orders 

them. 

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

More information

Visit Medicare.gov/coverage/artificial-eyes-limbs.

Bariatric surgery 

Medicare covers some bariatric surgical procedures, like gastric bypass surgery and 

laparoscopic banding surgery, when you meet certain conditions related to morbid 

obesity. 

Costs

For surgeries or procedures, it’s hard to know the exact costs in advance. This is 

because no one knows exactly what services you’ll need. If you need surgery or a 

procedure, you may be able to estimate how much you’ll have to pay. Visit 

Medicare.gov for more information. 

More information

Visit Medicare.gov/coverage/bariatric-surgery.
12 Section 2: Items & services

Behavioral health integration services 

Medicare may pay for a health care provider’s help to manage a behavioral health 

condition if your provider offers the Psychiatric Collaborative Care Model.

Costs

You pay a monthly fee, and the Part B deductible and coinsurance apply.

What it is

Behavioral health conditions include depression, anxiety, and other health 

conditions.

The Psychiatric Collaborative Care Model is a set of integrated behavioral 

health services that includes care management support if you have a behavioral 

health condition. This care management support may include care planning for 

behavioral health conditions, ongoing assessment of your condition, medication 

support, counseling, or other treatments that your provider recommends. Your 

health care provider will ask you to sign an agreement or provide verbal consent 

for you to get this set of services on a monthly basis. 

More information

Visit Medicare.gov/coverage/behavioral-health-integration-services.

Blood 

Part A covers blood you get as a hospital inpatient. Part B covers blood you get as 

a hospital outpatient. 

Costs

Visit Medicare.gov/coverage/blood for cost information. 

More information

Visit Medicare.gov/coverage/blood.
Section 2: Items & services 13

Blood processing & handling 

Hospitals usually charge for blood processing and handling for each unit of blood 

you get, whether the blood is donated or purchased. Part A covers this service if 

you’re an inpatient. Part B covers this service if you’re an outpatient. 

Costs

You pay a copayment for blood processing and handling services for each unit of 

blood you get as a hospital outpatient. 

More information

Visit Medicare.gov/coverage/blood-processing-handling.

Bone density 

See “Bone mass measurements” below. 

Bone mass measurements 

Part B covers this test if you meet one of more of these conditions:

• You’re a woman whose doctor determines you’re estrogen deficient and at risk 

for osteoporosis, based on your medical history and other findings.

• Your X-rays show possible osteoporosis, osteopenia, or vertebral fractures.

• You’re taking prednisone or steroid-type drugs or are planning to begin this 

treatment.

• You’ve been diagnosed with primary hyperparathyroidism.

• You’re being monitored to see if your osteoporosis drug therapy is working. 

How often

Once every 24 months or more often, if medically necessary.

Costs

You pay nothing for this test if your doctor or other qualified health care provider 

accepts assignment. 

What it is

This test helps to see if you’re at risk for broken bones.

More information

Visit Medicare.gov/coverage/bone-mass-measurement-bone-density.
14 Section 2: Items & services

Braces (arm, leg, back, & neck) 

Part B covers arm, leg, back, and neck braces when medically necessary.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

More information

Visit Medicare.gov/coverage/braces-arm-leg-back-neck.

Breast cancer screenings 

See “Mammograms” on page 61. 

Breast prostheses 

Part B covers some external breast prostheses (including a post-surgical bra) after a 

mastectomy. Part A covers surgically implanted breast prostheses after a mastectomy 

if the surgery takes place in an inpatient setting. Part B covers the surgery if it takes 

place in an outpatient setting.

Costs

You pay 20% of the Medicare-approved amount for your doctor’s services and the 

external breast prostheses. The Part B deductible applies. 

More information

• Surgeries to implant breast prostheses in a hospital inpatient setting covered 

under Part A: See “Inpatient hospital care” on page 53.

• Surgeries to implant breast prostheses in a hospital outpatient setting covered 

under Part B: See “Outpatient hospital services” on page 71.

• Visit Medicare.gov/coverage/breast-prostheses.
Section 2: Items & services 15

Canes 

Part B covers canes as durable medical equipment (DME). Medicare doesn’t cover 

white canes for the blind. 

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/canes.

Cardiac rehabilitation programs 

Part B covers these programs if you’ve had at least one of these conditions:

• A heart attack in the last 12 months

• Coronary artery bypass surgery

• Current stable angina pectoris (chest pain)

• A heart valve repair or replacement

• A coronary angioplasty (a medical procedure used to open a blocked artery) or 

coronary stenting (a procedure used to keep an artery open)

• A heart or heart-lung transplant

• Stable chronic heart failure

Part B also covers intensive cardiac rehabilitation (ICR) programs that usually include 

more rigorous or intense exercise, education, and counseling.

Costs

You pay 20% of the Medicare-approved amount if you get the services in your doctor’s 

office. In a hospital outpatient setting, you also pay the hospital a copayment. The 

Part B deductible applies. 

What it is

Programs include exercise, education, and counseling.
16 Section 2: Items & services

Cardiac rehabilitation programs (continued) 

Things to know

These programs may be provided in a hospital outpatient setting (including a critical 

access hospital) or in a doctor’s office.

Part B covers ICR programs if your doctor referred you and you had any of the 

conditions listed above.

More information

Visit Medicare.gov/coverage/cardiac-rehabilitation-programs.

Cardiovascular behavioral therapy 

Medicare covers a cardiovascular behavioral therapy visit with your primary care 

doctor or other primary care practitioner in a primary care setting (like a doctor’s 

office).

How often

One time each year.

Costs

You pay nothing if your doctor or other qualified health care provider accepts 

assignment. 

What it is

Cardiovascular behavioral therapy helps lower your risk for cardiovascular disease. 

During therapy, your doctor may discuss aspirin use (if appropriate), check your 

blood pressure, and give you tips to make sure you’re eating well.

More information

Visit Medicare.gov/coverage/cardiovascular-behavioral-therapy.
Section 2: Items & services 17

Cardiovascular disease screenings 

Part B covers cardiovascular screening blood tests. 

How often

Once every 5 years.

Costs

You pay nothing for the tests if your doctor or other qualified health care provider 

accepts assignment.

What it is

Blood tests for cholesterol, lipid, and triglyceride levels. These screenings include 

blood tests that help detect conditions that may lead to a heart attack or stroke. 

More information

Visit Medicare.gov/coverage/cardiovascular-disease-screenings.

Cataract surgery 

See “Eyeglasses & contact lenses” on page 41.

Cervical & vaginal cancer screenings 

Part B covers Pap tests and pelvic exams to check for cervical and vaginal cancers. 

As part of the pelvic exam, Medicare also covers a clinical breast exam to check for 

breast cancer.

How often

Medicare covers these screening tests once every 24 months. If you’re at high risk 

for cervical or vaginal cancer, or if you’re of child-bearing age and had an abnormal 

Pap test in the past 36 months, Medicare covers these screening tests once every 12 

months.

Part B also covers Human Papillomavirus (HPV) tests (as part of a Pap test) once 

every 5 years if you’re age 30-65 without HPV symptoms.
18 Section 2: Items & services

Cervical & vaginal cancer screenings (continued) 

Costs

You pay nothing for the lab Pap test and the lab HPV with Pap test if your doctor 

or other qualified health care provider accepts assignment. You also pay nothing for 

the Pap test specimen collection and pelvic and breast exams if your doctor or other 

qualified health care provider accepts assignment. 

More information

• See “Mammograms” on page 61.

• Visit Medicare.gov/coverage/cervical-vaginal-cancer-screenings.

Chemotherapy 

Part A covers chemotherapy if you have cancer, and you’re a hospital inpatient. 

Part B covers chemotherapy if you’re a hospital outpatient or a patient in a doctor’s 

office or freestanding clinic. 

Costs

You pay a copayment for chemotherapy covered under Part B in a hospital 

outpatient setting. For chemotherapy given in a doctor’s office or freestanding clinic, 

you pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

More information

• Chemotherapy in a hospital inpatient setting covered under Part A: 

See “Inpatient hospital care” on page 53.

• Visit Medicare.gov/coverage/chemotherapy.

Children’s kidney services 

Medicare covers dialysis and kidney transplants for children. 

More information

• Dialysis: See “Dialysis (children)” on pages 32–33.

• Kidney transplants: See “Kidney transplants (children)” on page 58.

• Visit Medicare.gov/publications to download and read the booklet “Medicare 

Coverage of Kidney Dialysis & Kidney Transplant Services.”
Section 2: Items & services 19

Chiropractic services 

Part B covers manual manipulation of the spine if medically necessary to correct a 

subluxation (when one or more of the bones of your spine move out of position) when 

provided by a chiropractor or other qualified provider. 

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Things to know

Medicare doesn’t cover other services or tests ordered by a chiropractor, including 

X-rays, massage therapy, and acupuncture. If you think your chiropractor is billing 

Medicare for services that aren’t covered, you can report suspected Medicare fraud by 

calling 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048. 

More information

Visit Medicare.gov/coverage/chiropractic-services.

Chronic care management services 

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.

Costs

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.

What is it

Chronic care management offers additional help managing chronic conditions like 

arthritis, asthma, diabetes, hypertension, heart disease, osteoporosis, and mental 

health and other conditions. This includes a comprehensive care plan that lists your 

health problems and goals, other health care providers, medications, community 

services you have and need, and other information about your health. It also explains 

the care you need and how your care will be coordinated. Your health care provider 

will ask you to sign an agreement to provide this service. If you agree, he or she will 

prepare the care plan, help you with medication management, provide 24/7 access 

for urgent care needs, give you support when you go from one health care setting 

to another, review your medicines and how you take them, and help you with other 

chronic care needs. 
20 Section 2: Items & services

Chronic care management services (continued)

Things to know

To get started, ask your health care professionals if they provide chronic care 

management services.

More information

Visit Medicare.gov/coverage/chronic-care-management-services.

Clinical laboratory tests 

Part B covers medically necessary clinical diagnostic laboratory services when your 

doctor or practitioner orders them. 

Costs

You pay nothing for Medicare-approved covered clinical diagnostic laboratory services.

What it is

Laboratory tests include certain blood tests, urinalysis, tests on tissue specimens, and 

some screening tests. 

More information

Visit Medicare.gov/coverage/clinical-laboratory-services.

Clinical research studies 

Part A and/or Part B cover some costs, like office visits and tests, in certain qualifying 

clinical research studies. 

Costs

You may pay 20% of the Medicare-approved amount, depending on the treatment you get. 

The Part B deductible may apply. 

What it is

Clinical research studies test how well different types of medical care work and if they’re 

safe, like how well a cancer drug works. These studies help doctors and researchers see if 

a new treatment works and if it’s safe. 

More information

Visit Medicare.gov/coverage/clinical-research-studies.
Section 2: Items & services 21

Colorectal cancer screenings 

Part B covers one or more of these tests:

• Multi-target stool DNA tests: See page 66.

• Screening barium enemas: See page 87.

• Screening colonoscopies: See page 88.

• Screening fecal occult blood tests: See page 88.

• Screening flexible sigmoidoscopies: See page 89. 

What it is

Tests to help find precancerous growths or find cancer early, when treatment is most 

effective. 

Colonoscopies 

See “Screening colonoscopies” on page 88.

Commode chairs 

Part B covers commode chairs as durable medical equipment (DME) when ordered by 

your doctor for use in your home if you’re confined to your bedroom. 

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/commode-chairs.
22 Section 2: Items & services

Concierge care 

Medicare doesn’t cover membership fees for concierge care. 

Costs

You pay 100% of the membership fee for concierge care. 

More information

Visit Medicare.gov/coverage/concierge-care.

Contact lenses 

See “Eyeglasses & contact lenses” on page 41. 

Continuous passive motion (CPM) machines 

Medicare covers knee CPM machines as durable medical equipment (DME) that 

your doctor prescribes for use in your home, if you meet certain conditions. 

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/continuous-passive-motion-machines.
Section 2: Items & services 23

Continuous Positive Airway Pressure (CPAP) devices, 

accessories, & therapy 

Medicare may cover CPAP therapy if you’ve been diagnosed with obstructive sleep 

apnea. 

How often

Medicare may covers a 3-month trial of CPAP therapy. Medicare may cover it longer 

if you meet in person with your doctor, and your doctor documents in your medical 

record that you meet certain conditions about the use of the device and the CPAP 

therapy is helping you.

Costs

You pay 20% of the Medicare-approved amount for the machine rental and purchase 

of related supplies (like masks and tubing), and the Part B deductible applies.

Things to know

• If you had a CPAP machine before you got Medicare, Medicare may cover 

rental or a replacement CPAP machine and/or CPAP accessories if you meet 

certain requirements.

• Medicare pays the supplier to rent the machine for 13 months if you’ve been 

using it without interruption. After you’ve rented the machine for 13 months, 

you own it.

• If you live in certain areas of the country, you may have to use specific 

suppliers for Medicare to pay for a CPAP machine and/or accessories. See 

“Durable medical equipment (DME)” on pages 36–38. 

More information

Visit Medicare.gov/coverage/continuous-positive-airway-pressure-devicesaccessories-therapy.
24 Section 2: Items & services

Cosmetic surgery 

Medicare usually doesn’t cover cosmetic surgery unless it’s needed because of 

accidental injury or to improve the function of a malformed body part. Medicare 

covers breast reconstruction if you had a mastectomy because of breast cancer. 

See “Breast prostheses” on page 14. 

Costs

You pay 100% for non-covered services, including most cosmetic surgery.

More information

Visit Medicare.gov/coverage/cosmetic-surgery.

Counseling to prevent tobacco use & tobacco-caused disease 

Part B covers smoking and tobacco-use cessation counseling visits. 

How often

Medicare covers up to 8 visits in a 12-month period.

Costs

You pay nothing for the counseling sessions if your doctor or other qualified health 

care provider accepts assignment.

What it is

Counseling to help you stop smoking or using tobacco. 

Things to know

A qualified doctor or other Medicare-recognized provider must provide these visits.

More information

Visit Medicare.gov/coverage/counseling-to-prevent-tobacco-use-tobacco-causeddisease.

Crutches 

Part B covers crutches as durable medical equipment (DME). 

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/crutches.
Section 2: Items & services 25

CT scans 

See “Diagnostic non-laboratory tests” on page 32.

Custodial care 

See “Nursing home care” on page 67.

Defibrillators 

Medicare may cover an implantable automatic defibrillator if you’ve been diagnosed 

with heart failure. Part A pays if the surgery takes place in a hospital inpatient 

setting. Part B pays if the surgery takes place in a hospital outpatient setting. 

Costs

Visit Medicare.gov/coverage/defibrillators for cost information.

More information

• Surgeries to implant defibrillators in the hospital inpatient setting covered 

under Part A: See “Inpatient hospital care” on page 53.

• Visit Medicare.gov/coverage/defibrillators.

Dental services 

Medicare doesn’t cover most dental care, procedures, or supplies, like cleanings, 

fillings, tooth extractions, dentures, dental plates, or other dental devices.

Part A will pay for certain dental services that you get when you’re in a hospital. 

Part A can pay for hospital stays if you need to have emergency or complicated 

dental procedures, even though the dental care isn’t covered.

Costs

You pay 100% for non-covered services, including most dental care.

More information

Visit Medicare.gov/coverage/dental-services.
26 Section 2: Items & services

Depression screenings 

Part B covers depression screenings. 

How often

Once per year. 

Costs

You pay nothing for this screening if your doctor accepts assignment. 

Things to know

The screening must be done in a primary care setting (like a doctor’s office) that can 

provide follow-up treatment and/or referrals.

More information

Visit Medicare.gov/coverage/depression-screenings.

Diabetes prevention program 

Part B covers a diabetes prevention program if all of these conditions apply to you:

• You have a hemoglobin A1c test result between 5.7 and 6.4%, a fasting plasma 

glucose of 110-125mg/dL, or a 2-hour plasma glucose of 140-199 mg/dL (oral 

glucose tolerant test) within 12 months prior to attending the first core session.

• You have a body mass index (BMI) of 25 or more (BMI of 23 or more if you’re 

Asian).

• You’ve never been diagnosed with type 1 or type 2 diabetes or End-Stage Renal 

Disease (ESRD).

• You’ve never participated in the Medicare Diabetes Prevention Program. 

How often

Once.

Costs

You pay nothing for these services.
Section 2: Items & services 27

Diabetes prevention program (continued) 

What it is

Medicare’s Diabetes Prevention Program is a proven health behavior change 

program to help you prevent type 2 diabetes. 

The program begins with 16 core sessions offered in a group setting over a 6-month 

period. In these sessions, you’ll get:

• Training to make realistic, lasting behavior changes

• Tips on how to get more exercise

• Strategies for controlling your weight

• A behavior coach, specially trained to help keep you motivated

• Support from people with similar goals

Once you complete the core sessions, you’ll get:

• 6 more months of less intensive monthly follow-up sessions to help you 

maintain healthy habits

• An additional 12 months of ongoing maintenance sessions if you meet certain 

weight loss and attendance goals

Things to know

To find a Medicare Diabetes Prevention Program supplier in your area, 

visit Medicare.gov/coverage/diabetes-prevention.

More information

Visit Medicare.gov/coverage/diabetes-prevention.
28 Section 2: Items & services

Diabetes screenings 

Part B covers these screenings if your doctor determines you’re at risk for diabetes 

or you’re diagnosed with pre-diabetes. These lab tests are covered if you have any of 

these risk factors:

• High blood pressure (hypertension)

• History of abnormal cholesterol and triglyceride levels (dyslipidemia)

• Obesity

• A history of high blood sugar (glucose)

Medicare also covers these if 2 or more of these apply to you:

• You’re age 65 or older.

• You’re overweight.

• You have a family history of diabetes (parents or siblings).

• You have a history of gestational diabetes (diabetes during pregnancy) or 

delivery of a baby weighing more than 9 pounds. 

How often

You may be eligible for up to 2 screenings each year. 

Costs

You pay nothing for these tests if your doctor or other qualified health care provider 

accepts assignment. 

More information

Visit Medicare.gov/coverage/diabetes-screenings.
Section 2: Items & services 29

Diabetes self-management training (DSMT) 

Part B covers outpatient DSMT if you’ve been diagnosed with diabetes.

Medicare may cover up to 10 hours of initial DSMT – 1 hour of individual 

training and 9 hours of group training. You may also qualify for up to 2 hours of 

follow-up training each year if it takes place in a calendar year after the year you got 

your initial training. 

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

What is it

DSMT teaches you to cope with and manage your diabetes. The program may 

include tips for eating healthy, being active, monitoring blood sugar, taking drugs, 

and reducing risks.

Things to know

You must have a written order from your doctor or qualified non-doctor 

practitioner.

Some exceptions apply if group sessions aren’t available or if your doctor or 

qualified non-doctor practitioner says you have special needs that would be better 

met by individual training sessions.

If you’re in a rural area, you may be able to get DSMT services from a practitioner, 

like a Registered Dietitian, in a different location through Telehealth. See 

“Telehealth” on page 95. 

More information

• Other diabetic services and supplies: See “Diabetes services” and “Diabetes 

supplies” on the next 2 pages.

• Visit Medicare.gov/coverage/diabetes-self-management-training.
30 Section 2: Items & services

Diabetes services 

Medicare may cover one or more of these items or services:

• Diabetes self-management training: See page 29.

• Eye exams (for diabetes): See page 41.

• Foot exams (for diabetes): See page 43.

• Glaucoma tests: See page 44. 

• Nutrition therapy services: See page 68.

More information

• Covered supplies if you have diabetes: See “Diabetes supplies” below.

• Visit Medicare.gov.

Diabetes supplies 

Part B covers some diabetes supplies, including:

• Blood sugar (glucose) testing monitors: Visit Medicare.gov/coverage/bloodsugar-monitors.

• Blood sugar test strips: Visit Medicare.gov/coverage/blood-sugar-test-strips.

• Blood sugar control solutions (for checking test strip and monitor accuracy): 

Visit Medicare.gov/coverage/glucose-control-solutions.

• Continuous glucose monitors and related supplies: Visit Medicare.gov/

coverage/therapeutic-continuous-glucose-monitors-cgms.

• Lancet devices and lancets: Visit Medicare.gov/coverage/lancet-devices-lancets.

• Insulin: See page 54.

• Therapeutic shoes or inserts: See page 96.

How often

There may be limits on how much or how often you get these supplies. For more 

information, see “Durable medical equipment (DME)” on pages 36–38.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Section 2: Items & services 31

Diabetes supplies (continued) 

Things to know

If you have Medicare prescription drug coverage (Part D), your plan may cover 

insulin, certain medical supplies used to inject insulin (like syringes), and some oral 

diabetes drugs. Check with your plan for more information.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Covered services if you have diabetes: See “Diabetes services” on page 30.

• Visit Medicare.gov.

Diagnostic laboratory tests 

Part B covers medically necessary clinical diagnostic laboratory tests, when your 

doctor or practitioner orders them. 

Costs

You usually pay nothing for Medicare-covered clinical diagnostic laboratory tests.

What it is

Tests done to help your doctor diagnose or rule out a suspected illness or condition. 

Things to know

Medicare also covers some preventive tests and screenings to help prevent, find, or 

manage a medical problem. For more information, see “Preventive services” on 

pages 80–81. 

More information

Visit Medicare.gov/coverage/diagnostic-laboratory-tests.
32 Section 2: Items & services

Diagnostic non-laboratory tests 

Part B covers these tests (like CT scans, MRIs, EKGs, X-rays, and PET scans) when 

your doctor or other health care provider orders them as part of treating a medical 

problem. 

Costs

You pay 20% of the Medicare-approved amount of covered diagnostic nonlaboratory tests done in your doctor’s office or in an independent testing facility, and 

the Part B deductible applies. You pay a copayment for diagnostic non-laboratory 

tests done in a hospital outpatient setting.

What it is

Tests done to help your doctor diagnose or rule out a suspected illness or condition. 

Things to know

Medicare also covers some preventive tests and screenings to help prevent, find, or 

manage a medical problem. For more information, see “Preventive services” on 

pages 80–81. 

More information

Visit Medicare.gov/coverage/diagnostic-non-laboratory-tests.

Dialysis (children) 

Part A and Part B cover different items and services for children’s dialysis.

If your child is in a hospital:

• Part A covers dialysis treatments.

• Part B covers doctors’ services.

If your child isn’t in a hospital, Part B helps pay for these dialysis services:

• Outpatient dialysis treatments (in a Medicare-approved dialysis facility)

• Home dialysis equipment and supplies

• Certain home support services

• Most injectable drugs and their oral forms for outpatient or home dialysis (like 

an erythropoiesis-stimulating agent to treat anemia)

• Doctors’ services (inpatient or outpatient)

• Other services that are part of dialysis, like laboratory tests

• Dialysis when you travel and use a Medicare-certified facility
Section 2: Items & services 33

Dialysis (children) (continued) 

Your child is eligible for Medicare if both you and your child meet these conditions:

One of these conditions applies to you:

• You (or your spouse) have earned at least 6 credits within the last 3 years by 

working and paying Social Security taxes.

• You (or your spouse) are getting, or are eligible for Social Security or Railroad 

Retirement Board benefits.

One of these conditions applies to your child:

• Your child needs regular dialysis because his or her kidneys no longer work.

• Your child has had a kidney transplant. 

Costs

• Inpatient hospital services: Part A pays for these services. You pay a deductible.

• Doctor’s services: Part B generally pays 80% of the Medicare-approved 

amount, after you pay the Part B yearly deductible. You pay the remaining 20% 

coinsurance. This is in addition to the Part B monthly premium. 

• Dialysis services: The amount you pay may vary based on your child’s age and 

the type of dialysis they need.

• In most cases, Medicare doesn’t pay for transportation to dialysis facilities.

If your child has other insurance, your costs may be different.

Things to know

If your child is eligible for Medicare only because of permanent kidney failure, 

Medicare coverage will end:

• 12 months after the last month of dialysis treatments

• 36 months after the month of a kidney transplant

Medicare coverage can be extended if your child meets certain conditions. 

More information

• Children’s kidney transplants: See “Kidney transplants (children).”

• Visit Medicare.gov/coverage/dialysis-children.

• Visit Medicare.gov/publications to download and read the booklet “Medicare 

Coverage of Kidney Dialysis & Kidney Transplant Services.”
34 Section 2: Items & services

Dialysis services & supplies 

Medicare covers many kidney dialysis services and supplies if you have End-Stage 

Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney 

transplant), including:

• Inpatient dialysis treatments: Part A covers dialysis if you’re in a Medicareapproved hospital. See “Inpatient hospital care” on page 53.

• Outpatient maintenance dialysis treatments: Part B covers a variety of services 

if you get routine dialysis in a Medicare-certified dialysis facility. For example, 

Part B covers ESRD-related laboratory tests and drugs (like heparin, topical 

anesthetics, and erythropoiesis-stimulating agents used to treat anemia related 

to your ESRD), but excludes ESRD-related drugs that only have an oral form of 

administration (drugs taken by mouth that only come in capsule, tablet, or liquid 

forms), which are covered only under Part D.

• Training for self-dialysis: Part B covers training if you’re a candidate for selfdialysis. Part B covers training provided during the course of your regular 

treatments for you and the person helping you with your self-dialysis treatments. 

A dialysis facility that’s been certified by Medicare to provide self-dialysis 

training must provide the training. Only dialysis facilities can bill Medicare 

(directly or under arrangement) for providing home dialysis training.

• Self-dialysis support services: Part B covers self-dialysis support services 

provided by your dialysis facility. This may include visits by trained hospital or 

dialysis facility workers to check on your self-dialysis, help in emergencies (when 

needed), and check your equipment and water supply.

• Self-dialysis equipment & supplies: Part B covers all dialysis equipment and 

supplies for as long as you need dialysis at home. Covered equipment and 

supplies include alcohol, wipes, dialysis machines, sterile drapes, rubber gloves, 

and scissors.

• Certain drugs for self-dialysis: Part B covers heparin, the antidote for heparin 

(when medically necessary), topical anesthetics, and erythropoiesis-stimulating 

agents (ESAs) (like epoetin alfa or darbepoetin alfa) to treat anemia related to your 

renal disease.

• Outpatient doctors’ services: Part B covers outpatient doctors’ services.

• Other dialysis services & supplies: Part B covers other services and supplies that 

are a part of dialysis (like laboratory tests).

• Ambulance transportation: In some cases, Medicare may cover ambulance 

transportation when you have ESRD, need dialysis, and need ambulance 

transportation to or from a dialysis facility.
Section 2: Items & services 35

Dialysis services & supplies (continued) 

Costs

• Inpatient dialysis treatments: If you have Original Medicare, Medicare pays most 

kidney doctors a monthly amount. After you pay the Part B yearly deductible, 

Medicare pays 80% of the monthly amount. You pay the remaining 20% coinsurance. 

In some cases, your doctor may be paid per day if you get services for less than one 

month.

• Outpatient maintenance dialysis treatments: Outpatient maintenance dialysis 

treatments include the cost of most dialysis drugs and biologicals. You pay 20% of 

the Medicare-approved amount for each dialysis treatment given in a dialysis facility 

or at home. The Part B deductible applies.

• Self-dialysis training, support services, equipment, & supplies: Outpatient 

maintenance dialysis treatment includes the cost of these. You pay 20% of the 

Medicare-approved amount, and the Part B deductible applies. Only dialysis facilities 

can bill Medicare (directly or under arrangement) for providing self-dialysis training.

• Certain drugs for self-dialysis: Outpatient maintenance dialysis treatment includes 

the costs of self-dialysis drugs and biologicals. You pay 20% of the Medicareapproved amount. ESRD-related drugs that only have an oral form of administration 

are covered only by Medicare prescription drug coverage (Part D). This means drugs 

taken by mouth that only come in capsule, tablet, or liquid forms.

Things to know

Medicare doesn’t cover these:

• Paid dialysis aides to help you with self-dialysis

• Any lost pay to you or the person who may be helping you during self-dialysis 

training

• A place to stay during your treatment

• Blood or packed red blood cells for self-dialysis unless part of a doctors’ service

There are some types of insurance that may pay some of the health care costs that 

Medicare doesn’t pay.

More information

• Visit Medicare.gov/coverage/dialysis-services-supplies.

• For information on dialysis for children, visit Medicare.gov/coverage/dialysis-children.

• Visit Medicare.gov/publications to download and read the booklet “Medicare 

Coverage of Kidney Dialysis & Kidney Transplant Services.”
36 Section 2: Items & services

Doctor & other health care provider services 

Part B covers medically necessary doctor services (including outpatient services 

and some doctor services you get when you’re a hospital inpatient) and covered 

preventive services. 

Costs

You pay 20% of the Medicare-approved amount for most services. You pay nothing 

for certain preventive services if your doctor or other provider accepts assignment. 

See “Preventive services” on pages 80–81. The Part B deductible applies. 

Things to know

A doctor can be a Doctor of Medicine (MD), a Doctor of Osteopathic Medicine 

(DO), or, in some cases, a dentist, podiatrist (foot doctor), optometrist (eye doctor), 

or chiropractor.

Medicare also covers services provided by other health care providers, like physician 

assistants, nurse practitioners, clinical nurse specialists, clinical social workers, 

physical therapists, occupational therapists, speech language pathologists, and 

clinical psychologists.

More information

Visit Medicare.gov/coverage/doctor-other-health-care-provider-services.

Drugs 

See “Prescription drugs (outpatient)” on pages 77–80.

Durable medical equipment (DME) 

Part B covers medically necessary DME if your doctor prescribes it for use in your 

home. Only your doctor can prescribe medical equipment for you. 
Section 2: Items & services 37

Durable medical equipment (DME) (continued) 

DME that Medicare covers includes, but isn’t limited to:

• Air-fluidized beds and other support surfaces (these supplies are only rented)

• Blood sugar monitors and test strips

• Canes

• Commode chairs 

• Continuous passive motion machines, devices, & accessories 

• Continuous Positive Airway Pressure

• Crutches 

• Enteral nutrition supplies & equipment (feeding pumps)

• Glucose control solutions 

• Hospital beds

• Hyperbaric oxygen (HBO) therapy 

• Infusion pumps and supplies 

• Nebulizers and nebulizer medications 

• Oxygen equipment and accessories 

• Patient lifts 

• Suction pumps 

• Traction equipment 

• Walkers

• Wheelchairs and scooters 

Costs

You pay 20% of the Medicare-approved amount for DME (if your supplier accepts 

assignment), and the Part B deductible applies. Visit Medicare.gov/coverage/

durable-medical-equipment-dme-coverage for more cost information.
38 Section 2: Items & services

Durable medical equipment (DME) (continued) 

What it is

DME is defined as equipment that meets these criteria:

• Durable (can withstand repeated use)

• Used for a medical reason

• Not usually useful to someone who isn’t sick or injured

• Used in your home

• Has an expected lifetime of at least 3 years

Things to know

Make sure your doctors and DME suppliers are enrolled in Medicare. Doctors and 

suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If 

your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims they submit.

It’s also important to ask your suppliers if they participate in Medicare before you 

get DME. If suppliers are participating suppliers, they must accept assignment (that 

is, they’re limited to charging you only coinsurance and the Part B deductible on 

the Medicare-approved amount). If suppliers are enrolled in Medicare but aren’t 

“participating,” they may choose not to accept assignment.

If suppliers don’t accept assignment, there’s no limit on the amount they can charge 

you. To find suppliers who accept assignment, visit Medicare.gov/supplier or call 

1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048.

Medicare pays for different kinds of DME in different ways: some equipment is rented, 

other equipment is purchased, and some equipment may be either rented or bought. 

More information

Visit Medicare.gov/coverage/durable-medical-equipment-dme-coverage.
Section 2: Items & services 39

EKG or ECG screenings 

Part B covers an electrocardiogram screening if you get a referral from your doctor 

or other health care provider as part of your one-time “Welcome to Medicare” 

preventive visit. EKGs are also covered as diagnostic tests. 

How often

Once when part of the “Welcome to Medicare” visit. More often when a diagnostic 

test. 

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

If you have the test at a hospital or a hospital-owned clinic, you also pay the hospital 

a copayment.

More information

• “Welcome to Medicare” visit: See “Preventive visits” pages 82–83.

• Diagnostic tests: See “Diagnostic non-laboratory tests” on page 32.

• Visit Medicare.gov/coverage/ekg-or-ecg-screenings.

Emergency department services 

Part B usually covers emergency department services when you have an injury, a 

sudden illness, or an illness that quickly gets much worse. 

Costs

• 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. 

• If you’re admitted to the same hospital for a related condition within 3 days of 

your emergency department visit, you don’t pay the copayment because your visit 

is considered to be part of your inpatient stay. 

Things to know

Medicare only covers emergency services in foreign countries only in rare 

circumstances. For more information, see “Travel” on pages 98–99.

More information

Visit Medicare.gov/coverage/emergency-department-services.
40 Section 2: Items & services

Enteral nutrition supplies & equipment 

Part B covers enteral nutrition supplies and equipment (feeding pumps) under the 

prosthetic device benefits. 

Costs

You pay 20% of the Medicare-approved amount. Medicare will cover your enternal 

infusion pump if your doctor or supplier is enrolled in Medicare. If a supplier 

doesn’t accept assignment, Medicare doesn’t limit how much the supplier can charge 

you. You may also have to pay the entire bill (your share and Medicare’s share) at the 

time you get the pump.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/enteral-nutrition-supplies-equipment.

Eye exams 

Medicare covers these preventive and diagnostic eye exams:

• Eye exams, if you have diabetes: See “Eye exams (for diabetes)” below.

• Glaucoma tests: See page 44.

• Macular degeneration tests & treatment: See page 61. 

More information

Visit Medicare.gov/coverage/eye-exams.

Eye exams (for diabetes) 

Part B covers eye exams for diabetic retinopathy if you have diabetes. 

How often

Once a year. 

Costs

You pay 20% of the Medicare-approved amount for your doctor’s services, and the 

Part B deductible applies. In a hospital outpatient setting, you pay a copayment.

Things to know

The exam must be done by an eye doctor who’s legally allowed to do the test in 

your state.
Section 2: Items & services 41

Eye exams (for diabetes) (continued) 

More information

• Other diabetic services and supplies: See “Diabetes services” and “Diabetes 

supplies” on pages 31–32.

• Visit Medicare.gov/coverage/eye-exams-for-diabetes.

Eye exams (routine) 

Medicare doesn’t cover eye exams (sometimes called “eye refractions”) for eyeglasses or 

contact lenses. 

Costs

You pay 100% for eye exams for eyeglasses or contact lenses.

More information

Visit Medicare.gov/coverage/eye-exams-routine.

Eyeglasses & contact lenses 

Medicare doesn’t usually cover eyeglasses or contact lenses. 

However, Part B helps pay for corrective lenses if you have cataract surgery to implant 

an intraocular lens. Corrective lenses include one pair of eyeglasses with standard 

frames or one set of contact lenses. 

Costs

You pay 100% for non-covered services, including most eyeglasses or contact lenses. 

You pay 20% of the Medicare-approved amount for corrective lenses after each 

cataract surgery with an intraocular lens, and the Part B deductible applies. You pay 

any additional costs for upgraded frames. Medicare will only pay for contact lenses 

or eyeglasses from a supplier enrolled in Medicare, no matter if you or your supplier 

submits the claim.

Things to know

Medicare covers cataract surgery if it’s done using traditional surgical techniques or 

using lasers.

More information

Visit Medicare.gov/coverage/eyeglasses-contact-lenses.
42 Section 2: Items & services

Eyes 

See “Artificial eyes & limbs” on page 11. 

Federally Qualified Health Center (FQHC) services 

Part B covers a broad range of outpatient primary care and preventive services in 

FQHCs.

Costs

You usually pay 20% of the charges or the Medicare-approved amount. You pay 

nothing for most preventive services.

More information

• To find a FQHC near you, visit findahealthcenter.hrsa.gov.

• Visit Medicare.gov/coverage/federally-qualified-health-center-fghc-services.

Feeding pumps 

See “Enteral nutrition supplies & equipment” on page 40. 

Flu shots 

Part B covers flu shots.

How often

One shot per flu season.

Costs

You pay nothing for a flu shot if your doctor or other qualified health care provider 

accepts assignment for giving the shot.

More information

Visit Medicare.gov/coverage/flu-shots.
Section 2: Items & services 43

Foot care 

Part B covers podiatrist (foot doctor) foot exams or treatment if you have diabetesrelated nerve damage or need medically necessary treatment for foot injuries or 

diseases, like hammer toe, bunion deformities, and heel spurs.

Medicare doesn’t usually cover routine foot care, like cutting or removing corns 

and calluses, trimming, cutting, or clipping nails, or hygienic or other preventive 

maintenance, like cleaning and soaking your feet. 

Costs

• You pay 20% of the Medicare-approved amount for medically necessary 

treatment provided by your doctor, and the Part B deductible applies. 

• In a hospital outpatient setting, you also pay a copayment for medically 

necessary treatment.

More information

• If you have diabetes, see “Therapeutic shoes or inserts” on page 96 and “Foot care 

(for diabetes)” below. 

• Visit Medicare.gov/coverage/foot-care.

Foot care (for diabetes) 

Part B covers foot exams if you have diabetic peripheral neuropathy and loss of 

protective sensations. 

How often

Every 6 months, as long as you haven’t seen a foot care professional for another reason 

between visits.

Costs

• You pay 20% of the Medicare-approved amount for your doctor’s services, and 

the Part B deductible applies. 

• In a hospital outpatient setting, you pay a copayment.

More information

• See “Therapeutic shoes or inserts” on page 96. 

• Visit Medicare.gov/coverage/foot-care-for-diabetes.
44 Section 2: Items & services

Foot care (routine) 

Medicare doesn’t usually cover routine foot care. 

Costs

You pay 100% for routine foot care, in most cases.

What it is

Routine foot care includes:

• Cutting or removing corns and calluses.

• Trimming, cutting, or clipping nails.

• Hygiene or other preventive maintenance, like cleaning or soaking your feet.

More information

Visit Medicare.gov/coverage/foot-care-routine.

Glaucoma tests 

Part B covers glaucoma tests if you’re at high risk for glaucoma. You’re at high risk if 

one or more of these applies to you:

• You have diabetes.

• You have a family history of glaucoma.

• You’re African American and age 50 or older.

• You’re Hispanic and age 65 or older. 

How often

Once every 12 months.

Costs

• You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

• In a hospital outpatient setting, you also pay a copayment.

Things to know

An eye doctor who’s legally allowed to do this test in your state must do or supervise 

the screening.

More information

Visit Medicare.gov/coverage/glaucoma-tests.
Section 2: Items & services 45

Gym memberships & fitness programs 

Medicare doesn’t cover gym membership or fitness programs.

Costs

You pay 100% for non-covered services, including gym membership and fitness 

programs.

More information

Visit Medicare.gov/coverage/gym-membership-fitness-programs.

Health education & wellness programs 

Medicare usually doesn’t cover health education and wellness programs, but it does cover:

• Alcohol misuse screenings and counseling: See page 9.

• Counseling to prevent tobacco use and tobacco-caused disease: See page 24.

• Diabetes prevention program: See pages 26–27.

• Diabetes self-management training: See page 29.

• Depression screenings: See page 26.

• Kidney disease education: See page 55.

• Nutrition therapy, if you have diabetes or kidney disease: See page 68.

• Obesity behavioral therapy: See page 69.

• A “Welcome to Medicare” preventive visit: See page 82.

• Yearly “Wellness” visits: See pages 82–83. 

Hearing & balance exams 

Part B covers diagnostic hearing and balance exams if your doctor or other health care 

provider orders them to see if you need medical treatment. 

Costs

• You pay 20% of the Medicare-approved amount for your doctor’s services for 

covered exams, and the Part B deductible applies. 

• In a hospital outpatient setting, you also pay the hospital a copayment.

More information

Visit Medicare.gov/coverage/hearing-balance-exams.
46 Section 2: Items & services

Hearing aids 

Medicare doesn’t cover hearing aids or exams for fitting hearing aids.

Costs

You pay 100% for hearing aids and exams.

More information

Visit Medicare.gov/coverage/hearing-aids.

Hepatitis B shots 

Part B covers these shots if you’re at medium or high risk for Hepatitis B. Your risk for 

Hepatitis B increases if one or more of these applies to you:

• You have hemophilia.

• You have End-Stage Renal Disease (ESRD) (permanent kidney failure requiring 

dialysis or a kidney transplant).

• You have diabetes.

• You live with someone who has Hepatitis B.

• You’re a health care worker and have frequent contact with blood or bodily 

fluids.

Other factors may also increase your risk for Hepatitis B. Check with your doctor to 

see if you’re at high or medium risk for Hepatitis B.

Costs

You pay nothing for the shot if your doctor or other qualified health care provider 

accepts assignment. 

More information

Visit Medicare.gov/coverage/hepatitis-b-shots.
Section 2: Items & services 47

Hepatitis B Virus (HBV) infection screenings 

Medicare covers HBV infection screenings if you’re at high risk or pregnant.

How often

• Once a year if you’re at continued high risk and don’t get a Hepatitis B shot. 

• If you’re pregnant:

– At the first prenatal visit for each pregnancy.

– At the time of delivery for those with new or continued risk factors.

– At the first prenatal visit for future pregnancies, even if you previously got 

the Hepatitis B shot or had negative HBV screening results.

Costs

You pay nothing for the screening test if your doctor or other qualified health care 

provider accepts assignment.

Things to know

Your primary care doctor must order the infection screening.

More information

Visit Medicare.gov/coverage/hepatitis-b-virus-infection-screenings. 

Hepatitis C screening tests 

Medicare covers a screening test if you meet one or more of these conditions:

• You’re at high risk because you use or have used illicit injection drugs.

• You had a blood transfusion before 1992.

• You were born between 1945-1965.

Medicare usually covers repeat screenings for people at high risk. 

How often

Once, if you meet one of the conditions listed above. If you’re at high risk, Medicare 

covers yearly screenings.

Costs

You pay nothing for the screening test if your doctor or other qualified health care 

provider accepts assignment.
48 Section 2: Items & services

Hepatitis C screening tests (continued) 

Things to know

Medicare will only cover Hepatitis C screening tests if your primary care doctor or 

other primary care provider orders them.

More information

Visit Medicare.gov/coverage/hepatitis-c-screening-tests.

HIV screenings 

Part B covers an HIV (Human Immunodeficiency Virus) screening if you meet one 

of these conditions:

• You’re age 15–65.

• You’re younger than 15 or older than 65 and are at an increased risk for HIV.

How often

Once per year, if you meet the conditions above. If you’re pregnant, you can get the 

screening up to 3 times during your pregnancy.

Costs

You pay nothing for the test if your doctor or other qualified health care provider 

accepts assignment.

More information

Visit Medicare.gov/coverage/hiv-screenings.
Section 2: Items & services 49

Home health services 

Part A and/or Part B cover eligible home health services if you meet certain 

conditions. Visit Medicare.gov/coverage/home-health-services for more information.

Costs

• You pay nothing for all covered home health visits. 

• You pay 20% of the Medicare-approved amount, and the Part B deductible 

applies, for Medicare-covered medical equipment.

What it is

Eligible home health services include:

• Part-time or intermittent skilled nursing care

• Part-time or intermittent home health aide care

• Physical therapy

• Occupational therapy

• Speech-language pathology services

• Medical social services

Medicare doesn’t pay for:

• 24-hour-a-day care at home

• Meals delivered to your home

• Custodial or personal care (help bathing, dressing, and using the bathroom) 

when this is the only care you need

• Homemaker services

Things to know

Home health services may also include injectable osteoporosis drugs for women. 

See “Osteoporosis drugs” on page 68.

More information

• Visit Medicare.gov/coverage/home-health-services.

• Visit Medicare.gov/publications to download and read the booklet “Medicare & 

Home Health Care.”
50 Section 2: Items & services

Hospice care 

If you have Part A and meet all of these conditions, you can get hospice care:

• Your hospice doctor and your regular doctor (if you have one) certify that you’re 

terminally ill (with a life expectancy of 6 months or less).

• You accept palliative care (for comfort) instead of care to cure your illness.

• You sign a statement choosing hospice care instead of other Medicare-covered 

benefits to treat your terminal illness and related conditions.

Costs

• You pay nothing for hospice care.

• You may need to pay a copayment of no more than $5 for each prescription drug 

and other similar products for pain relief and symptom control while you’re 

at home. In the rare case your drug isn’t covered by the hospice benefit, your 

hospice provider should contact your Medicare drug plan to see if it’s covered 

under Part D.

• You may need to pay 5% of the Medicare-approved amount for inpatient respite 

care.

• Medicare doesn’t cover room and board when you get hospice care in your home 

or another facility where you live (like a nursing home).

What it is

Depending on your terminal illness and related conditions, the plan of care your 

hospice team creates can include any or all of these services:

• Doctor services

• Nursing care

• Medical equipment, like wheelchairs or walkers

• Medical supplies, like bandages or catheters

• Prescription drugs for symptom control or pain relief

• Hospice aide and homemaker services

• Physical therapy services

• Occupational therapy services

• Speech-language pathology services

• Social work services

• Dietary counseling
Section 2: Items & services 51

Hospice care (continued) 

• Grief and loss counseling for you and your family

• Short-term inpatient care for pain and symptom management

• Short-term respite care. If your usual caregiver (like a family member) needs a rest, 

you can get inpatient respite care in a Medicare-approved facility (like a hospice 

inpatient facility, hospital, or nursing home). Your hospice provider will arrange 

this for you. You can stay up to 5 days each time you get respite care. You can get 

respite care more than once, but it can only be provided on an occasional basis.

• Any other Medicare-covered services needed to manage your pain and 

other symptoms related to your terminal illness and related conditions, as 

recommended by your hospice team.

Things to know

Hospice care is usually given in your home but may also be covered in a hospice 

inpatient facility. Original Medicare will still pay for covered benefits for any health 

problems that aren’t part of your terminal illness and related conditions, but this 

is unusual. Once you choose hospice care, your hospice benefit will usually cover 

everything you need.

More information

• Visit Medicare.gov/coverage/hospice-care.

• Visit Medicare.gov/publications to download and read the booklet “Medicare 

Hospice Benefits.”

Hospital beds 

Part B covers hospital beds as durable medical equipment (DME) that your doctor 

prescribes for use in your home.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/hospital-beds.

Human Papillomavirus (HPV) tests 

See “Cervical & vaginal cancer screenings” on pages 17–18.
52 Section 2: Items & services

Humidifiers 

Medicare doesn’t usually cover humidifiers or other similar items, like room heaters, 

dehumidifiers, or electric air cleaners.

However, Medicare covers oxygen humidifiers used with certain covered durable 

medical equipment (DME) when medically necessary.

Costs

You pay 100% for most humidifiers or other similar items. You won’t have to pay a 

separate amount for an oxygen humidifier. The cost of an oxygen humidifier will be 

included in the monthly fee for your oxygen equipment.

More information

Visit Medicare.gov/coverage/humidifiers.

Hyperbaric oxygen (HBO) therapy 

Medicare covers HBO therapy, if you meet certain conditions. Visit Medicare.gov/

coverage/hyperbaric-oxygen-hbo-therapy for the full list of covered conditions.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible may apply.

What it is

HBO therapy is a process in which your entire body is exposed to oxygen under 

increased atmospheric pressure.

Things to know

The therapy must be administered in a chamber (including a one-person unit).

More information

Visit Medicare.gov/coverage/hyperbaric-oxygen-hbo-therapy.

Incontinence supplies & adult diapers 

Medicare doesn’t cover incontinence supplies or adult diapers.

Costs

You pay 100% for incontinence supplies and adult diapers.

More information

Visit Medicare.gov/coverage/incontinence-supplies-adult-diapers.
Section 2: Items & services 53

Inpatient hospital care 

Part A covers inpatient hospital care when all of these are true:

• You’re admitted to the hospital as an inpatient after an official doctor’s order, 

which says you need inpatient hospital care to treat your illness or injury.

• The hospital accepts Medicare.

• In certain cases, the Utilization Review Committee of the hospital approves your 

stay while you’re in the hospital.

Costs

You pay this for each benefit period (in 2019):

• Days 1-60: $1,364 deductible.

• Days 61-90: $341 coinsurance each day.

• Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 

90 for each benefit period (up to 60 days over your lifetime).

• Each day after the lifetime reserve days: all costs. Inpatient mental health care in 

a psychiatric hospital is limited to 190 days in a lifetime.

What it is

Medicare-covered hospital services include:

• Semi-private rooms

• Meals

• General nursing, drugs as part of your inpatient treatment

• Other hospital services and supplies

This doesn’t include private-duty nursing, a television or phone in your room (if there’s 

a separate charge for these items), or personal care items, like razors or slipper socks. It 

also doesn’t include a private room, unless medically necessary.

Things to know

This includes care you get in acute care hospitals, critical access hospitals, inpatient 

rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying 

clinical research study, and mental health care.

Part B covers your doctors’ services you get while you’re in a hospital.

More information

• Mental health care: See page 62.

• Outpatient hospital services: See pages 71–72.

• Visit Medicare.gov/coverage/inpatient-hospital-care.
54 Section 2: Items & services

Insulin 

Part B doesn’t cover insulin (unless use of an insulin pump is medically necessary), 

insulin pens, syringes, needles, alcohol swabs, or gauze.

Costs

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 applies). You pay 100% for 

syringes and needles, unless you have Part D.

Things to know

Part D may cover insulin and certain medical supplies used to inject insulin, like 

syringes, gauze, and alcohol swabs. However, if you use an external insulin pump, 

insulin and the pump may be covered as durable medical equipment under Part B. 

“Durable medical equipment (DME)” on pages 36–38.

More information

• Other diabetic services and supplies: See “Diabetes services” and “Diabetes 

supplies” on pages 30–31.

• Visit Medicare.gov/coverage/insulin.
Section 2: Items & services 55

Kidney disease education 

Medicare covers up to 6 sessions of kidney disease education services if you have Stage 

IV chronic kidney disease that will usually require dialysis or a kidney transplant.

Costs

You pay 20% of the Medicare-approved amount per session if you get the service from 

a doctor or other qualified health care provider, and the Part B deductible applies.

What it is

Kidney disease education teaches you how to take the best possible care of your 

kidneys and gives you information you need to make informed decisions about your 

care. 

Things to know

This is covered if your doctor or other health care provider refers you for the service, 

and when the service is given by a doctor, certain qualified non-doctor provider, or 

certain rural provider.

More information

Visit Medicare.gov/coverage/kidney-disease-education.

Kidney services & supplies 

See “Dialysis services & supplies” on pages 34–35.
56 Section 2: Items & services

Kidney transplants 

Part A and Part B cover different items and services related to kidney transplants.

Part A covers transplant services and pays part of the costs for these:

• Inpatient services in a Medicare-certified hospital.

• Kidney registration fee.

• Laboratory and other tests needed to evaluate your medical condition and the 

medication condition of potential kidney donors.

• Finding the proper kidney for your transplant surgery (if there’s no kidney 

donor).

• The full cost of care for your kidney donor (including care before surgery, the 

actual surgery, and care after surgery).

• Any additional inpatient hospital care for your donor in case of problems due to 

surgery.

• Blood (whole units of packed red blood cells, blood components, and the cost of 

processing and giving you blood).

Part B covers transplant services and pays part of the costs for these:

• Doctors’ services for kidney transplant surgery (including care before surgery, 

the actual surgery, and care after surgery).

• Doctors’ services for your kidney donor during their hospital stay.

• Transplant drugs also called immunosuppressive drugs (for a limited time after 

you leave the hospital following a transplant).

• Blood. 

Medicare will only pay for your transplant drug therapy for 36 months after the 

month of the kidney transplant if both of these apply:

• You’re entitled to Medicare only because of permanent kidney failure.

• You have the pancreas transplant after the kidney transplant.
Section 2: Items & services 57

Kidney transplants (continued) 

This is because your Medicare coverage will end 36 months after a successful kidney 

transplant if you only have Medicare due to permanent kidney failure.

Medicare will continue to pay for your transplant drugs (also called 

immunosuppressive drugs) with no time limit if either of these apply:

• You were already entitled to Medicare because of age or disability before you got 

ESRD.

• You became eligible for Medicare because of age or disability after getting a 

transplant.

Costs

You pay:

• 20% of the Medicare-approved amount.

• Various amounts for transplant facility charges.

• Nothing for a living donor for a kidney transplant.

• Nothing for Medicare-approved laboratory tests.

Things to know

These services are covered if they’re done by the Medicare-certified hospital where 

you’ll get your transplant or another hospital that participates in Medicare.

More information

• Other types of Medicare-covered transplants: See “Transplants” on pages 97–98.

• Kidney transplants for children: See “Kidney transplants (children)” on the next 

page.

• Visit Medicare.gov/coverage/kidney-transplants.

• Visit Medicare.gov/publications to download and read the booklet “Medicare 

Coverage of Kidney Dialysis & Kidney Transplant Services.”
58 Section 2: Items & services

Kidney transplants (children) 

Part A and Part B cover different items and services related to children’s kidney 

transplants.

Part A usually covers these transplant services:

• Inpatient services in an approved hospital

• Kidney registry fee

• Laboratory and other tests needed to evaluate your child’s medical condition and 

the condition of possible kidney donors

• The costs of finding the proper kidney for your child’s transplant surgery

• The full cost of care for your child’s kidney donor

• Blood (if a transfusion is needed)

Part B helps pay for these transplant services:

• Doctors’ services for kidney transplant surgery

• Doctors’ services for the kidney donor during his or her hospital stay

• Immunosuppressive drugs (generally for a limited time after your child leaves 

the hospital following a transplant)

• Blood (if a transfusion is needed)

Costs

• Part A usually pays for inpatient hospital services, and you pay a one-time yearly 

deductible. 

• For Part B services, Medicare generally pays 80% of the Medicare-approved 

amount, after you pay the Part B yearly deductible. You pay the remaining 20% 

coinsurance. This is in addition to the Part B monthly premium.

• For dialysis services covered under Part B, the amount you pay may vary based 

on your age and the type of dialysis your child needs. 

• If your child has other insurance, your costs may be different.

More information

• Children’s dialysis: See “Dialysis (children)” on pages 32–33.

• Visit Medicare.gov/coverage/kidney-transplants-children.

• Visit Medicare.gov/publications to download and read the booklet “Medicare 

Coverage of Kidney Dialysis & Kidney Transplant Services.”
Section 2: Items & services 59

Laboratory tests 

• Clinical laboratory tests: See page 20.

• Diagnostic laboratory tests: See page 31.

• Diagnostic non-laboratory tests: See page 32. 

Long-term care 

Medicare doesn’t cover long-term care (also called custodial care), if that’s the only 

care you need. Most nursing home care is custodial care.

Costs

You pay 100% for non-covered services, including most long-term care.

What it is

Long-term care is a range of services and support for your personal care needs. Most 

long-term care isn’t medical care. Instead, most long-term care is help with basic 

personal tasks of everyday life, sometimes called activities of daily living.

More information

Visit Medicare.gov/coverage/long-term-care.

Long-term care hospital services 

Part A covers care in long-term care hospitals (LTCHs). 

Costs

You won’t usually pay more for care in a LTCH than in an acute care hospital. Under 

Medicare, you’re only responsible for one deductible for any benefit period. This 

applies whether you’re in an acute care hospital or a LTCH.

You don’t have to pay a second deductible for your care in a LTCH if:

• You’re transferred to a LTCH directly from an acute care hospital

• You’re admitted to a LTCH within 60 days of being discharged from an inpatient 

hospital stay

If you’re admitted to the LTCH more than 60 days after any previous hospital stay:

• A new benefit period begins.

• You’ll have to pay a deductible and coinsurance because you’re in a new benefit 

period. These charges are the same as if you were being admitted to an acute care 

hospital.
60 Section 2: Items & services

Long-term care hospital services (continued) 

What it is

LTCHs specialize in treating patients when both of these apply:

• They may have more than one serious condition.

• They may improve with time and care, and return home.

More information

Visit Medicare.gov/coverage/long-term-care-hospitals-services.

Lung cancer screenings 

Part B covers lung cancer screenings with Low Dose Computed Tomography (LDCT) 

if you meet all of these conditions:

• You’re age 55–77.

• You don’t have signs or symptoms of lung cancer (asymptomatic).

• You’re either a current smoker or have quit smoking within the last 15 years.

• You have a tobacco smoking history of at least 30 “pack years” (an average of one 

pack (20 cigarettes) per day for 30 years).

• You get a written order from your doctor.

How often

Once per year.

Costs

You pay nothing for this service if your doctor accepts assignment.

Things to know

Before your first lung cancer screening, you’ll need to schedule a lung cancer 

screening counseling and shared decision making visit with your doctor to discuss the 

benefits and risks of lung cancer screening. You and your doctor can decide whether 

lung cancer screening is right for you

More information

Visit Medicare.gov/coverage/lung-cancer-screenings.
Section 2: Items & services 61

Macular degeneration tests & treatment 

Part B may cover certain diagnostic tests and treatment (including treatment with 

certain injected drugs) of eye diseases and conditions if you have age-related macular 

degeneration (AMD).

Costs

• You pay 20% of the Medicare-approved amount for the drug and your doctor’s 

services, and the Part B deductible applies. 

• In a hospital outpatient setting, you pay a copayment.

More information

Visit Medicare.gov/coverage/macular-degeneration-tests-treatment.

Mammograms 

Part B covers:

• A baseline mammogram if you’re a woman between ages 35–39.

• Screening mammograms if you’re a woman age 40 or older.

• Diagnostic mammograms. 

How often

• Baseline mammogram: One time.

• Screening mammograms: Once every 12 months.

• Diagnostic mammograms: More frequently than once a year, if medically 

necessary.

Costs

• Screening mammograms: You pay nothing for the test if your doctor or other 

qualified health care provider accepts assignment. 

• Diagnostic mammograms: You pay 20% of the Medicare-approved amount, and 

the Part B deductible applies.

What it is

These screenings checks for breast cancer.

More information

Visit Medicare.gov/coverage/mammograms.
62 Section 2: Items & services

Massage therapy 

Medicare doesn’t cover massage therapy.

Costs

You pay 100% for non-covered services, including massage therapy.

More information

Visit Medicare.gov/coverage/massage-therapy.

Mental health care (inpatient) 

Part A covers mental health care services you get in a hospital that require you to be 

admitted as an inpatient.

Costs

• $1,364 deductible for each benefit period.

• Days 1–60: $0 coinsurance per day of each benefit period.

• Days 61–90: $341 coinsurance per day of each benefit period.

• Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 

90 for each benefit period (up to 60 days over your lifetime).

• Beyond lifetime reserve days: all costs.

• 20% of the Medicare-approved amount for mental health services you get from 

doctors and other providers while you’re a hospital inpatient.

What it is

Mental health services help with conditions like depression and anxiety.

Things to know

You can get these services either in a general hospital or a psychiatric hospital that 

only cares for people with mental health conditions.

If you’re in a psychiatric hospital (instead of a general hospital), Part A only pays for 

up to 190 days of inpatient psychiatric hospital services during your lifetime.

Medicare doesn’t cover:

• Private duty nursing

• A phone or television in your room

• Personal items, like toothpaste, socks, or razors

• A private room, unless medically necessary
Section 2: Items & services 63

Mental health care (inpatient) (continued) 

More information

• Visit Medicare.gov/publications to download and read the booklet “Medicare & 

Your Mental Health Benefits.”

• Visit Medicare.gov/coverage/mental-health-care-inpatient.

Mental health care (outpatient) 

Part B helps pay for these covered outpatient mental health services:

• One depression screening per year. The screening must be done in a primary 

care doctor’s office or primary care clinic that can provide follow-up treatment 

and referrals. See “Depression screenings” on page 26.

• Individual and group psychotherapy with doctors or certain other licensed 

professionals allowed by the state where you get the services.

• Family counseling, if the main purpose is to help with your treatment.

• Testing to find out if you’re getting the services you need and if your current 

treatment is helping you.

• Psychiatric evaluation.

• Medication management.

• Certain prescription drugs that aren’t usually “self administered” (drugs you 

would normally take on your own), like some injections.

• Diagnostic tests.

• Partial hospitalization. See “Mental health care (partial hospitalization)” on the 

next page.

• A one-time “Welcome to Medicare” preventive visit. This visit includes a review 

of your possible risk factors for depression. See “Preventive visits” on page 82.

• A yearly “Wellness” visit. Talk to your doctor or other health care provider about 

changes in your mental health. They can evaluate your changes year to year. See 

“Preventive visits” on page 82.

Part B also covers outpatient mental health services for treatment of inappropriate 

alcohol and drug use.
64 Section 2: Items & services

Mental health care (outpatient) (continued) 

Costs

• You pay nothing for your yearly depression screening if your doctor or health 

care provider accepts assignment.

• 20% of the Medicare-approved amount for visits to your doctor or other health 

care provider to diagnose or treat your condition. The Part B deductible applies.

• If you get your services in a hospital outpatient clinic or hospital outpatient 

department, you may have to pay an additional copayment or coinsurance 

amount to the hospital.

What it is

Mental health services help with conditions like depression and anxiety. These visits 

are often called counseling or therapy.

Things to know

Part B covers mental health services and visits with these types of health professionals: 

psychiatrists or other doctors, clinical psychologists, clinical social workers, clinical 

nurse specialists, nurse practitioners, and physician assistants.

Part B covers outpatient mental health services, including services that are usually 

provided outside a hospital, like in these settings: a doctor’s or other health care 

provider’s office, a hospital outpatient department, or a community mental health center.

More information

• Visit Medicare.gov/publications to download and read the booklet “Medicare & 

Your Mental Health Benefits.”

• Visit Medicare.gov/coverage/mental-health-care-outpatient.
Section 2: Items & services 65

Mental health care (partial hospitalization) 

Part B may cover services under a partial hospitalization program if you meet certain 

requirements and your doctor certifies that you would otherwise need inpatient treatment.

Costs

• You pay a percentage of the Medicare-approved amount for each service you get 

from a doctor or certain other qualified mental health professionals if your health 

care professional accepts assignment.

• You also pay coinsurance for each day of partial hospitalization services provided 

in a hospital outpatient setting or community mental health center, and the Part B 

deductible applies.

What it is

Partial hospitalization provides a structured program of outpatient psychiatric services as 

an alternative to inpatient psychiatric care. It’s more intense than care you get in a doctor’s 

or therapist’s office. This treatment is provided during the day and doesn’t require an 

overnight stay. Medicare helps cover partial hospitalization services when they’re provided 

through a hospital outpatient department or community mental health center.

Things to know

Along with your partial hospitalization program, Medicare may cover occupational 

therapy that’s part of your mental health treatment and individual patient training and 

education about your condition.

Medicare only covers partial hospitalization if the doctor and the partial hospitalization 

program accept assignment. Medicare doesn’t cover:

• Meals

• Transportation to or from mental health care services

• Support groups that bring people together to talk and socialize. (This is different 

from group psychotherapy, which is covered.)

• Testing or training for job skills that isn’t part of your mental health treatment.

More information

• Visit Medicare.gov/publications to download and read the booklet “Medicare & 

Your Mental Health Benefits.”

• Visit Medicare.gov/coverage/mental-health-care-partial-hospitalization.
66 Section 2: Items & services

Multi-target stool DNA tests 

Medicare covers this at-home multi-target stool DNA lab test if you meet all of these 

conditions:

• You’re age 50–85.

• You show no symptoms of colorectal disease including, but not limited to, lower 

gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or 

fecal immunochemical test.

• You’re at average risk for developing colorectal cancer, meaning:

– You have no personal history of adenomatous polyps, colorectal cancer, 

or inflammatory bowel disease, including Crohn’s Disease and ulcerative 

colitis.

– You have no family history of colorectal cancers or adenomatous polyps, 

familial adenomatous polyposis, or hereditary nonpolyposis colorectal 

cancer.

How often

Once every 3 years.

Cost

You pay nothing for this test if your doctor or other qualified health care provider 

accepts assignment.

More information

Visit Medicare.gov/coverage/multi-target-stool-dna-tests.

MRIs 

See “Diagnostic non-laboratory tests” on page 32.
Section 2: Items & services 67

Nebulizers & nebulizer medications 

Part B covers nebulizers (and some medicines used in nebulizers if considered 

reasonable and necessary). These are covered as durable medical equipment (DME) 

that your doctor prescribes for use in your home.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/nebulizers-nebulizer-medications.

Nursing home care 

Medicare doesn’t cover custodial care if it’s the only care you need. Most nursing 

home care is custodial care. Custodial care helps you with activities of daily living (like 

bathing, dressing, using the bathroom, and eating) or personal needs that could be 

done safely and reasonably without professional skills or training.

Part A may cover care in a certified skilled nursing facility (SNF). It must be medically 

necessary for you to have skilled nursing care (like changing sterile dressings).

More information

• Visit Medicare.gov/coverage/nursing-home-care.

• Visit Medicare.gov/publications to download and read the booklet “Your Guide 

to Choosing a Nursing Home or Other Long Term Services & Supports.”
68 Section 2: Items & services

Nutrition therapy services 

Part B may cover medical nutrition therapy (MNT) services and certain related 

services if you have diabetes or kidney disease, or you’ve had a kidney transplant in 

the last 36 months.

Costs

You pay nothing for these preventive services because the Part B deductible and 

coinsurance don’t apply.

What it is

Services may include:

• An initial nutrition and lifestyle assessment

• Individual and/or group nutritional therapy services

• Help managing the lifestyle factors that affect your diabetes

• Follow-up visits to check on your progress in managing your diet

Things to know

A Registered Dietitian or nutrition professional who meets certain requirements can 

provide MNT services, but only your doctor can refer you for the service.

If you get dialysis in a dialysis facility, Medicare covers MNT as part of your overall 

dialysis care.

If you’re in a rural area, a Registered Dietitian or other nutritional professional in a 

different location may be able to provide MNT to you through Telehealth. 

See “Telehealth” on page 95.

More information

Visit Medicare.gov/coverage/nutrition-therapy-services.
Section 2: Items & services 69

Obesity behavioral therapy 

Medicare covers obesity screenings and behavioral counseling if you have a body 

mass index (BMI) of 30 or more. 

Costs

You pay nothing for this service if your primary care doctor or other qualified 

primary care practitioner accepts assignment.

What it is

An initial screening for BMI and behavioral therapy sessions that include a dietary 

assessment and counseling to help you lose weight by focusing on diet and exercise.

Things to know

This counseling may be covered if you get it from your doctor or other primary care 

practitioner in a primary care setting (like a doctor’s office).

More information

Visit Medicare.gov/coverage/obesity-screening-behavioral-therapy.

Observation services 

See “Outpatient hospital services” on page 71. 

Occupational therapy 

Part B helps pay for medically necessary outpatient occupational therapy.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

Things to know

Medicare law no longer limits how much it pays for your medically necessary 

outpatient therapy services in one calendar year.

More information

Visit Medicare.gov/coverage/occupational-therapy.
70 Section 2: Items & services

Orthopedic shoes 

Medicare covers orthopedic shoes if they’re a necessary part of a leg brace.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

Things to know

You must go to a supplier that’s enrolled in Medicare for Medicare to cover your 

orthotics. Medicare will only pay for orthotic items furnished by a supplier enrolled 

in Medicare, no matter who submits the claim (you or your supplier).

More information

• See “Therapeutic shoes or inserts” on page 96.

• Visit Medicare.gov/coverage/orthopedic-shoes.

Osteoporosis drugs 

Part A and Part B help pay for an injectable drug for osteoporosis and visits by a 

home health nurse to inject the drug if you meet these conditions:

• You’re a woman.

• You’re eligible for Part B and meet the criteria for Medicare home health 

services. See “Home health services” on page 49.

• You have a bone fracture that a doctor certifies is related to postmenopausal 

osteoporosis.

• Your doctor certifies that you’re unable to learn to give yourself the drug by 

injection and your family members and/or caregivers are unable and unwilling 

to give you the drug by injection.

Costs

You pay 20% of the Medicare-approved amount for the cost of the drug, and the Part B 

deductible applies. You pay nothing for the home health nurse visit to inject the drug. 

More information

• Home health care: See page 49.

• Visit Medicare.gov/coverage/osteoporosis-drugs.
Section 2: Items & services 71

Ostomy supplies 

Part B covers medically necessary ostomy supplies if you’ve had a colostomy, 

ileostomy, or urinary ostomy. Medicare covers the amount of supplies your doctor 

says you need, based on your condition.

Costs

You pay 20% of the Medicare-approved amount for your doctor’s services and 

supplies, and the Part B deductible applies. 

Things to know

Medicare covers these supplies as prosthetic devices.

More information

Visit Medicare.gov/coverage/ostomy-supplies.

Outpatient hospital services 

Part B covers medically necessary diagnostic and treatment services you get as an 

outpatient from a Medicare-participating hospital.

Covered outpatient hospital services may include:

• Emergency or observation services, which may include an overnight stay in the 

hospital or services in an outpatient clinic, including same-day surgery.

• Laboratory tests billed by the hospital.

• Mental health care in a partial hospitalization program, if a doctor certifies that 

inpatient treatment would be required without it. See “Mental health care (partial 

hospitalization)” on page 65.

• X-rays and other radiology services billed by the hospital.

• Medical supplies, like splints and casts.

• Screenings and preventive services. See page 80.

• Certain drugs and biologicals that you wouldn’t usually give yourself. 
72 Section 2: Items & services

Outpatient hospital services (continued) 

Costs

• You usually pay 20% of the Medicare approved amount for the doctor’s or other 

health care provider’s services. For services that can also be provided in a doctor’s 

office, you may pay more for services you get in a hospital outpatient setting than 

you’ll pay for the same care in a doctor’s office. However, the hospital outpatient 

copayment for the service is capped at the inpatient deductible amount.

• In addition to the amount you pay the doctor, you’ll also usually pay the hospital 

a copayment for each service you get in a hospital outpatient setting, except 

for certain preventive services that don’t have a copayment. In most cases, the 

copayment can’t be more than the Part A hospital stay deductible for each service.

• The Part B deductible applies, except for certain preventive services. If you get 

hospital outpatient services in a critical access hospital, your copayment may be 

higher and may exceed the Part A hospital stay deductible. 

More information

Visit Medicare.gov/coverage/outpatient-hospital-services.

Outpatient medical & surgical services & supplies 

Part B covers approved procedures, like X-rays, casts, stitches, or outpatient surgeries. 

Costs

You pay 20% of the Medicare-approved amount for your doctor’s or other health care 

provider’s services. You usually pay the hospital a copayment for each service you get in 

a hospital outpatient setting. There are exceptions for costly surgical procedures (called 

“comprehensive services”), like total knee replacements. For these services, you pay 20% 

for the entire episode of care, including any drugs, laboratory tests, and other services.

In most cases, for each service provided, the copayment can’t be more than the Part A 

hospital stay deductible. The Part B deductible applies, and you pay all costs for items or 

services that Medicare doesn’t cover. 

More information

Visit Medicare.gov/coverage/outpatient-hospital-services.
Section 2: Items & services 73

Oxygen equipment & accessories 

Part B covers the rental of oxygen equipment and accessories as durable medical 

equipment (DME) that your doctor prescribes for use in your home.

If you own your own equipment, Medicare will help pay for oxygen contents and 

supplies for the delivery of oxygen when all of these conditions are met:

• Your doctor says you have a severe lung disease or you’re not getting enough 

oxygen.

• Your health might improve with oxygen therapy.

• Your arterial blood gas level falls within a certain range.

• Other alternative measures have failed.

If you meet the conditions above, Medicare helps pay for:

• Systems that provide oxygen

• Containers that store oxygen

• Tubing and related supplies for the delivery of oxygen and oxygen contents

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/oxygen-equipment-accessories.
74 Section 2: Items & services

Pancreas transplants 

Medicare covers pancreas transplants under certain conditions. If you have EndStage Renal Disease (ESRD) and need a pancreas transplant, Medicare covers the 

transplant if one of these applies:

• It’s done at the same time you get a kidney transplant.

• It’s done after a kidney transplant.

In some cases, Medicare may cover a pancreas transplant even if you don’t need a 

kidney transplant.

Part B will pay for your transplant drugs (also called immunosuppressive drugs) 

with no time limit if either of these apply:

• You were entitled to Medicare because of age or disability.

• You became eligible for Medicare because of age or disability after getting a 

transplant.

Part B will only pay for your transplant drug therapy for 36 months after the month 

of the kidney transplant if both of these apply:

• You’re entitled to Medicare only because of permanent kidney failure.

• You have the pancreas transplant after the kidney transplant.

This is because your Medicare coverage will end 36 months after a successful kidney 

transplant if you only have Medicare due to permanent kidney failure.

Costs

You pay:

• 20% of the Medicare-approved amount for doctors’ services.

• Various amounts for transplant facility charges. You pay nothing for a living 

donor for a kidney transplant.

• Nothing for Medicare-approved laboratory tests. 

More information

• Other types of Medicare-covered transplants: See “Transplants” on pages 

97–98.

• Visit Medicare.gov/coverage/pancreas-transplants.
Section 2: Items & services 75

Pap tests 

See “Cervical & vaginal cancer screenings” on pages 17–18.

Patient lifts 

Part B covers patient lifts as durable medical equipment (DME) that your doctor 

prescribes for use in your home.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/patient-lifts. 

PET scans 

See “Diagnostic non-laboratory tests” on page 32.

Physical therapy 

Part B helps pay for medically necessary outpatient physical therapy.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

Things to know

Medicare law no longer limits how much it pays for your medically necessary 

outpatient therapy services in one calendar year.

More information

Visit Medicare.gov/coverage/physical-therapy. 

Power wheelchairs 

See “Walkers & wheelchairs” on page 100.
76 Section 2: Items & services

Pneumococcal shots 

Part B covers 2 different pneumococcal shots. 

How often

Part B covers the first shot at any time and a different, second shot if it’s given at least 

one year after the first shot.

Costs

You pay nothing for pneumococcal shots if your doctor or other qualified health care 

provider accepts assignment for giving the shot. 

What it is

The 2 shots protect against different strains of the bacteria.

Things to know

Talk with your doctor or other health care provider to see if you need one or both 

shots. 

More information

Visit Medicare.gov/coverage/pneumococcal-shots.
Section 2: Items & services 77

Prescription drugs (outpatient) 

Part B covers a limited number of outpatient prescription drugs under limited 

conditions.

Usually, drugs covered under Part B are drugs you wouldn’t usually give to yourself, 

like those you get at a doctor’s office or hospital outpatient setting.

Here are some examples of drugs covered by Part B:

• Drugs used with an item of durable medical equipment (DME): Medicare 

covers drugs infused through DME, like an infusion pump or drugs given by a 

nebulizer.

• Some antigens: Medicare helps pay for antigens if they’re prepared by a doctor 

and are given by a properly instructed person (who could be you, the patient) 

under appropriate supervision.

• Injectable osteoporosis drugs: Medicare helps pay for an injectable drug if 

you’re a woman with osteoporosis who meets the criteria for the Medicare home 

health benefit and has a bone fracture that a doctor certifies was related to postmenopausal osteoporosis. A doctor must certify that you can’t give yourself the 

injection or learn how to give yourself the drug by injection. The home health 

nurse or aide won’t be covered to provide the injection unless family and/or 

caregivers are unable or unwilling to give you the drug by injection.

• Erythropoiesis-stimulating agents: Medicare helps pay for erythropoietin by 

injection if you have End-Stage Renal Disease (ESRD) or you need this drug to 

treat anemia related to certain other conditions.

• Blood clotting factors: Medicare helps pay for clotting factors you give yourself 

by injection, if you have hemophilia.

• Injectable and infused drugs: Medicare covers most of these when given by a 

licensed medical provider.

• Oral End-Stage Renal Disease (ESRD) drugs: Medicare helps pay for some 

oral ESRD drugs if the same drug is available in injectable form and the drug is 

covered under the Part B ESRD benefit.

Note: Part B covers calcimimetic medications under the ESRD payment 

system, including the intravenous medication Parsabiv, and the oral medication 

Sensipar. Your ESRD facility is responsible for giving you these medications. 

They can give them to you at their facility, or through a pharmacy they work 

with. You’ll need to work with your ESRD facility and your doctor to find out 

where you’ll get these medications and how much you’ll pay.
78 Section 2: Items & services

Prescription drugs (outpatient) (continued) 

• Parental and enternal nutrition (intravenous and tube feeding): Medicare 

helps pay for certain nutrients if you can’t absorb nutrition through your 

intestinal tract or take food by mouth. 

• Intravenous Immune Globulin (IVIG) provided in home: Medicare helps pay 

for IVIG if you have a diagnosis of primary immune deficiency disease. A doctor 

must decide that it’s medically appropriate for the IVIG to be given in your 

home. Part B covers the IVIG itself. But, Part B doesn’t pay for other items and 

services related to you getting the IVIG at home.

• Shots (vaccinations): Medicare covers flu shots, pneumococcal shots, Hepatitis 

B shots, and some other vaccines when they’re related directly to the treatment 

of an injury of illness.

• Transplant / immunosuppressive drugs: Medicare covers transplant drug 

therapy if Medicare helped pay for your organ transplant. Medicare won’t pay for 

any services or items, including transplant drugs, for patients who aren’t entitled 

to Medicare.

Part D may cover other transplant drugs that Part B doesn’t cover, even if 

Medicare didn’t pay for the transplant. If you have ESRD and Original Medicare, 

you may join a Medicare drug plan.

If you’re entitled to Medicare only because of ESRD, your Medicare coverage 

ends 36 months after the month of the transplant.

Medicare will pay for your transplant drugs with no time limit if you were 

already entitled to Medicare because of age or disability before you got ESRD or 

you became entitled to Medicare because of your age or disability after getting a 

transplant that was paid for by Medicare or private insurance that paid primary 

to your Part A coverage, in a Medicare-certified facility.

Transplant drugs can be very costly. If you’re worried about paying for them after 

your Medicare coverage ends, talk to your doctor, nurse, or social worker. There 

may be other ways to help you pay for these drugs.
Section 2: Items & services 79

Prescription drugs (outpatient) (continued) 

• Oral cancer drugs: Medicare helps pay for some oral cancer drugs you take by 

mouth if the same drug is available in injectable form or the drug is a prodrug 

of the injectable drug. A prodrug is an oral form of a drug that, when ingested, 

breaks down into the same active ingredient found in the injectable drug. As 

new oral cancer drugs become available, Part B may cover them.

• Oral anti-nausea drugs: Medicare helps pay for oral anti-nausea drugs used 

as part of an anti-cancer chemotherapeutic regimen if they’re administered 

before, at, or within 48 hours of chemotherapy or are used as a full therapeutic 

replacement for an intravenous anti-nausea drug.

• Self-administered drugs in hospital outpatient savings: Medicare may pay for 

some self-administered drugs, like drugs given through an IV. Medicare pays for 

these drugs if you need them for the hospital outpatient services you’re getting.

Costs

You pay 20% of the Medicare-approved amount for covered Part B prescription 

drugs that you get in a doctor’s office or pharmacy, and the Part B deductible applies. 

In a hospital outpatient setting, you pay a copayment of 20%. If your hospital is 

participating in a certain outpatient drug discount program (called “340B”), your 

copayment will be 20% of the lower price, with some exceptions. Doctors and 

pharmacies must accept assignment for Part B drugs, so you should never be asked 

to pay more than the coinsurance or copayment for the Part B drug itself.

If you get drugs that Part B doesn’t cover in a hospital outpatient setting, you pay 

100% for the drugs, unless you have Part D or other prescription drug coverage. In 

that case, what you pay depends on whether your drug plan covers the drug, and 

whether the hospital is in your drug plan’s network. Contact your prescription drug 

plan to find out what you pay for drugs you get in a hospital outpatient setting that 

Part B doesn’t cover.
80 Section 2: Items & services

Prescription drugs (outpatient) (continued) 

Things to know

Drugs not covered under Part B may be covered under Medicare Part D (Medicare 

prescription drug coverage). If you have Part D, check your plan’s drug list 

(formulary) to see what outpatient drugs are covered.

More information

• Visit Medicare.gov/coverage/prescription-drugs-outpatient.

• Visit Medicare.gov/publications to download and read the booklet “Your Guide 

to Medicare Prescription Drug Coverage.”

Preventive services 

Part B covers many preventive services. Each covered preventive service in this 

booklet has a picture of an apple next to it. Talk with your doctor about which 

preventive services are right for you. 

What it is

Preventive services help you stay healthy, can find health problems early, when 

treatment works best, and can keep you from getting certain diseases. Preventive 

services include exams, shots, lab tests, and screenings. They also include programs 

for health monitoring, and counseling and education to help you take care of your 

own health. Talk with your doctor about which preventive services are right for you.

Here’s the full list of all covered preventive and screening services:

• Abdominal aortic aneurysm screenings: See page 7.

• Alcohol misuse screenings & counseling: See page 9.

• Bone mass measurements: See page 13.

• Cardiovascular behavioral therapy: See page 16.

• Cardiovascular disease screenings: See page 17.

• Cervical & vaginal cancer screenings: See pages 17–18.

• Colorectal cancer screening: See page 21.

• Counseling to prevent tobacco use and tobacco-caused disease: See page 24.

• Depression screenings: See page 26.

• Diabetes prevention program: See pages 26–27.
Section 2: Items & services 81

Preventive services (continued) 

• Diabetes screenings: See page 28.

• Diabetes self-management training: See page 29.

• Glaucoma tests: See page 44.

• Hepatitis B Virus (HBV) infection screenings: See page 47.

• Hepatitis C screening tests: See pages 47–48.

• HIV screenings: See page 48.

• Lung cancer screenings: See page 60.

• Mammograms screening: See page 61. 

• Obesity behavioral therapy: See page 69.

• Preventive visits: See page 82.

• Prostate cancer screenings: See page 83.

• Shots: See page 91.

• Sexually transmitted infection screening & counseling: See page 90. 

More information

Visit Medicare.gov/coverage/preventive-screening-services.
82 Section 2: Items & services

Preventive visits 

“Welcome to Medicare” preventive visits

Part B covers a “Welcome to Medicare” preventive visit. 

How often

Once. You must have the preventive visit within the first 12 months you have Part B.

Costs

You pay nothing for the visit if your doctor or other qualified health care provider 

accepts assignment. The Part B deductible doesn’t apply. However, you may have to 

pay coinsurance, and the Part B deductible may apply if:

• Your doctor or other health care provider performs additional tests or services 

during the same visit.

• These additional tests or services aren’t covered under the preventive benefits.

What it is

This visit includes a review of your medical and social history related to your health 

education, and counseling about preventive services.

Things to know

When you make your appointment, let your doctor’s office know you would like to 

schedule your “Welcome to Medicare” preventive visit. 

More information

Visit Medicare.gov/coverage/welcome-to-medicare-preventive-visit.

Yearly “Wellness” visits

If you’ve had Part B for longer than 12 months, you can get a yearly “Wellness” visit 

to develop or update a personalized prevention plan to help prevent disease and 

disability, based on your current health and risk factors. 

How often

Once every 12 months.
Section 2: Items & services 83

Preventive visits (continued) 

Costs

You pay nothing for this visit if your doctor or other qualified health care provider 

accepts assignment. The Part B deductible doesn’t apply. However, you may have to 

pay coinsurance, and the Part B deductible may apply if:

• Your doctor or other health care provider performs additional tests or services 

during the same visit.

• These additional tests or services aren’t covered under the preventive benefits.

What it is

Your provider will ask you to fill out a questionnaire, called a “Health Risk 

Assessment,” as part of this visit. Answering these questions can help you and your 

provider develop a personalized prevention plan to help you stay healthy and get the 

most out of your visit. Visit Medicare.gov/coverage/yearly-wellness-visits for more 

information. 

More information

Visit Medicare.gov/coverage/yearly-wellness-visits.

Prostate cancer screenings 

Part B covers digital rectal exams and prostate specific antigen (PSA) blood tests for 

men over 50 (beginning the day after your 50th birthday). 

How often

Once every 12 months.

Costs

• Digital rectal exams: You pay 20% of the Medicare-approved amount for a yearly 

digital rectal exam and for your doctor’s services related to the exam, and the Part B 

deductible applies. In a hospital outpatient setting, you pay a copayment.

• PSA blood tests: You pay nothing for a yearly PSA blood test. If you get the test 

from a doctor that doesn’t accept assignment, you may have to pay an additional 

fee for your doctor’s services, but not for the test itself.

More information

Visit Medicare.gov/coverage/prostate-cancer-screenings.
84 Section 2: Items & services

Prosthetic devices 

Part B covers prosthetic devices needed to replace a body part or function when a 

doctor or other health care provider enrolled in Medicare orders them. 

Costs

You pay 20% of the Medicare-approved amount for external prosthetic devices, and 

the Part B deductible applies. 

What it is

Prosthetic devices include:

• Breast prostheses (including a surgical bra). See “Breast prostheses” on page 14.

• One pair of conventional eyeglasses or contact lenses provided after a cataract 

operation.

• Ostomy bags and certain related supplies. See “Ostomy supplies” on page 71.

• Some surgically implanted prosthetic devices, including cochlear implants.

• Urological supplies.

Things to know

You must go to a supplier that’s enrolled in Medicare for Medicare to pay for your 

device. Part A or Part B covers surgically implanted prosthetic devices depending on 

whether the surgery takes place in an inpatient or outpatient setting.

Medicare will only pay for prosthetic items furnished by a supplier enrolled in 

Medicare, no matter who submits the claim (you or your supplier). 

More information

• Surgeries to implant prosthetic devices in a hospital inpatient setting covered 

under Part A: See “Inpatient hospital care” on page 53.

• For surgeries to implant prosthetic devices in a hospital outpatient setting 

covered under Part B: See “Outpatient hospital services” on page 71.

• Visit Medicare.gov/coverage/prosthetic-devices.
Section 2: Items & services 85

Pulmonary rehabilitation programs 

Part B covers a comprehensive pulmonary rehabilitation program if you have 

moderate to very severe chronic obstructive pulmonary disease (COPD). 

Costs

You pay 20% of the Medicare-approved amount if you get the service in your doctor’s 

office. You also pay a copayment per session if you get the service in a hospital 

outpatient setting. The Part B deductible applies. 

What it is

These programs help you breathe better, get stronger, and be able to live more 

independently.

Things to know

These services may be provided in a doctor’s office or a hospital outpatient setting 

that offers pulmonary rehabilitation programs. You need a referral for pulmonary 

rehabilitation from the doctor treating this chronic respiratory disease. 

More information

Visit Medicare.gov/coverage/pulmonary-rehabilitation-programs.

Radiation therapy 

Part A covers radiation therapy for hospital inpatients. Part B covers this therapy for 

outpatients or patients in freestanding clinics.

Costs

• If you’re an inpatient, you pay the Part A deductible and coinsurance (if 

applicable).

• If you’re an outpatient, you pay a set copayment. The Part B deductible applies.

• In a freestanding clinic, you pay 20% of the Medicare-approved amount for the 

therapy. The Part B deductible applies. 

More information

Visit Medicare.gov/coverage/radiation-therapy.

Rectal exams 

See “Prostate cancer screenings” on page 83.
86 Section 2: Items & services

Religious nonmedical health care institution items & services 

Medicare may cover items and services in RNHCIs only if you qualify for hospital 

or skilled nursing facility (SNF) care. Medicare will also only cover the inpatient 

non-religious, non-medical items and services, like room and board and any items 

or services that don’t require a doctor’s order or prescription, including unmedicated 

wound dressings or use of a simple walker.

Medicare doesn’t cover the religious portion of religious nonmedical health care 

institution (RNHCI) care. However, Part A covers inpatient non-religious, nonmedical care when these conditions are met:

• The RNHCI is currently certified to participate in Medicare.

• The RNHCI Utilization Review Committee agrees that you would require 

hospital or SNF care if you weren’t in the RNHCI.

• You have a written election on file with Medicare indicating that your need for 

RNHCI care is based on both your eligibility and religious beliefs. The election 

must also indicate that if you decide to accept standard medical care, you’ll 

revoke the election and may have to wait 1-5 years (depending on how many 

times you may have previously revoked your election) to be eligible for a new 

election to get RNHCI services. You’re always eligible to get medically necessary 

Part A services.

Costs

• $1,364 deductible for each benefit period.

• Days 1–60: $0 coinsurance for each benefit period.

• Days 61–90: $341 coinsurance per day of each benefit period.

• Days 91 and beyond: $682 coinsurance per each “lifetime reserve day” after day 

90 for each benefit period (up to 60 days over your lifetime).

• Beyond lifetime reserve days: all costs. 

Things to know

Religious beliefs prohibit conventional and unconventional medical care in RNHCIs.

More information

Visit Medicare.gov/coverage/religious-non-medical-health-care-institution-itemsservices.
Section 2: Items & services 87

Respite care 

See “Hospice care” on pages 50–51.

Rural health clinic (RHC) services 

Part B covers a broad range of outpatient primary care and preventive services in 

RHCs. 

Costs

You generally pay 20% of the charges, and the Part B deductible applies. You pay 

nothing for most preventive services. 

What it is

RHCs furnish many outpatient primary care and preventive health services. RHCs are 

located in non-urbanized areas that are in medically underserved or shortage areas. 

More information

Visit Medicare.gov/coverage/rural-health-clinic-rhc-services.

Scooters 

See “Walkers & wheelchairs” on page 100. 

Screening barium enemas 

Part B covers this test if you’re age 50 or older.

How often

When this test is used instead of a flexible sigmoidoscopy or colonoscopy, Medicare 

covers the test once every 48 months if you’re age 50 or older and once every 24 

months if you’re at high risk for colorectal cancer.

Costs

You pay 20% of the Medicare-approved amount for your doctor’s services. In a 

hospital outpatient setting, you also pay a copayment. The Part B deductible doesn’t 

apply. 

More information

Visit Medicare.gov/coverage/screening-barium-enemas.
88 Section 2: Items & services

Screening colonoscopies 

Medicare covers screening colonoscopies. 

How often

Medicare covers this test once every 24 months if you’re at high risk for colorectal 

cancer. If you aren’t at high risk for colorectal cancer, Medicare covers the test once 

every 120 months, or 48 months after a previous flexible sigmoidoscopy. There’s no 

minimum age requirement.

Costs

You pay nothing for this test if your doctor or other qualified health care provider 

accepts assignment. 

However, if a polyp or other tissue is found and removed during the colonoscopy, 

you may pay 20% of the Medicare-approved amount of your doctor’s services and a 

copayment in a hospital setting. The Part B deductible doesn’t apply. 

More information

Visit Medicare.gov/coverage/screening-colonoscopies.

Screening fecal occult blood tests 

Medicare covers screening fecal occult blood tests.

How often

Medicare covers this lab test once every 12 months if you’re 50 or older. 

Costs

You pay nothing for this test if your doctor or other qualified health care provider 

accepts assignment.

Things to know

You must get a referral from your doctor, physician assistant, nurse practitioner, or 

clinical nurse specialist. 

More information

Visit Medicare.gov/coverage/screening-fecal-occult-blood-tests.
Section 2: Items & services 89

Screening flexible sigmoidoscopies 

Medicare covers screening flexible sigmoidoscopies. 

How often

Medicare covers this test once every 48 months for most people 50 or older. If you 

aren’t at high risk, Medicare covers this test 120 months after a previous screening 

colonoscopy.

Costs

You pay nothing if your doctor or other qualified health care provider accepts 

assignment.

If a screening flexible sigmoidoscopy results in the biopsy or removal of a lesion or 

growth during the same visit, the procedure is considered diagnostic and you may 

have to pay coinsurance and/or a copayment, but the Part B deductible doesn’t apply. 

More information

Visit Medicare.gov/coverage/screening-flexible-sigmoidoscopies.

Second surgical opinions 

Part B covers a second surgical opinion in some cases for surgery that isn’t an 

emergency. Medicare also will help pay for a third opinion if the first and second 

opinions are different. 

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. If 

the second opinion doesn’t agree with the first opinion, you pay 20% of the Medicareapproved amount for a third opinion.

What it is

A second opinion is when another doctor gives their view about your health problem 

and how it should be treated. 

More information

Visit Medicare.gov/coverage/second-surgical-opinions.
90 Section 2: Items & services

Sexually transmitted infections screenings & counseling 

Part B covers sexually transmitted infection (STI) screenings for chlamydia, gonorrhea, 

syphilis, and/or Hepatitis B if you’re pregnant or at increased risk for an STI.

Medicare also covers up to 2 individual 20-30 minute, face-to-face, high-intensity 

behavioral counseling sessions if you’re a sexually active adolescent or adult at 

increased risk for STIs. 

How often

Medicare covers these tests once every 12 months or at certain times during 

pregnancy. Medicare covers behavioral counseling sessions once each year.

Costs

You pay nothing if your doctor accepts assignment.

Things to know

You doctor must order the test or refer you for behavioral counseling. Medicare 

will only cover counseling sessions if they’re provided by a doctor and take place in 

a primary care doctor’s office or primary care clinic. Counseling conducted in an 

inpatient setting, like a skilled nursing facility, won’t be covered as a preventive service. 

More information

Visit Medicare.gov/coverage/sexually-transmitted-infections-screenings-counseling.

Shingles shots 

Part A and Part B don’t cover the shingles shot. Usually, Part D plans cover all 

commercially available vaccines needed to prevent illness. 

More information

• Contact your Medicare drug plan.

• Visit Medicare.gov/coverage/shingles-shot.
Section 2: Items & services 91

Shots 

Part B covers:

• Flu shots: See page 42.

• Hepatitis B shots: See page 46.

• Pneumococcal shots: See page 76.

• Some other vaccines when they’re related directly to the treatment of an injury 

of illness. These aren’t considered preventive services.

Skilled nursing facility (SNF) care 

Part A covers skilled nursing care provided in a SNF in certain conditions for a 

limited time if all of these conditions are met:

• You have Part A and have days left in your benefit period to use.

• You have a qualifying inpatient hospital stay.

• Your doctor has decided that you need daily skilled care. It must be given by, or 

under the supervision of, skilled nursing or therapy staff.

• You get these skilled services in a SNF that’s certified by Medicare.

• You need these skilled services for a medical condition that’s either:

– A hospital-related medical condition.

– A condition that started while you were getting care in the SNF for a 

hospital-related medical condition. 

How often

Medicare covers certain daily skilled care services on a short-term basis.
92 Section 2: Items & services

Skilled nursing facility (SNF) care (continued) 

Costs

You pay these amounts (in 2019) for each benefit period (following at least a 3-day 

medically necessary inpatient hospital stay for a related illness or injury or for a 

condition that started while you were getting care in the SNF for a hospital-related 

medical condition):

• Days 1–20: $0 each benefit period

• Days 21–100: up to $170.50 each day

• Beyond 100 days: 100% of all costs

There’s a limit of 100 days of Part A SNF coverage in each benefit period.

What it is

Skilled care is nursing and therapy care that can only be safely and effectively 

performed by, or under the supervision of, professionals or technical personnel. It’s 

health care given when you need skilled nursing or skilled therapy to treat, manage, 

and observe your condition, and evaluate your care. Medicare-covered services 

include, but aren’t limited to:

• Semi-private room (a room you share with other patients).

• Meals.

• Skilled nursing care.

• Physical and occupational therapy, if they’re needed to meet your health goal. 

See pages 69 and 75.

• Speech-language pathology services, if they’re needed to meet your health goal. 

See page 93.

• Medical social services.

• Medications.

• Medical supplies and equipment used in the facility.

• Ambulance transportation (when other transportation endangers health) to the 

nearest supplier of needed services that aren’t available at the SNF.

• Dietary counseling.

More information

Visit Medicare.gov/coverage/skilled-nursing-facility-snf-care.
Section 2: Items & services 93

Sleep studies 

Part B covers Type I, II, III, and IV sleep tests and devices if you have clinical signs 

and symptoms of sleep apnea.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Things to know

Medicare only covers Type I tests if they’re done in a sleep lab facility. Your doctor 

must order the test. 

More information

Visit Medicare.gov/coverage/sleep-studies.

Speech-language pathology services 

Part B helps pay for medically necessary outpatient speech-language pathology 

services.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. 

Things to know

Medicare law no longer limits how much it pays for your medically necessary 

outpatient therapy services in one calendar year. 

More information

Visit Medicare.gov/coverage/speech-language-pathology-services.

Supplies 

Part B usually doesn’t cover common medical supplies, like bandages and gauze, 

which you use at home.

Costs

You pay 100% for most common medical supplies you use at home. 

More information

Visit Medicare.gov/coverage/supplies.
94 Section 2: Items & services

Surgery 

Medicare covers many medically necessary surgical procedures.

Costs

For surgeries or procedures, it’s hard to know the exact costs in advance. This is 

because no one knows exactly what services you’ll need. If you need surgery or a 

procedure, you may be able to estimate how much you’ll have to pay. Visit 

Medicare.gov/coverage/surgery for more cost information

More information

Visit Medicare.gov/coverage/surgery.

Surgical dressing services 

Part B covers medically necessary treatment of a surgical or surgically treated wound.

Costs

You pay nothing for the supplies and 20% of the Medicare-approved amount for your 

doctor or other health care provider’s services. You pay a fixed copayment for these 

services when you get them in a hospital outpatient setting. The Part B deductible 

applies. 

More information

Visit Medicare.gov/coverage/surgical-dressing-services.

Swing bed services 

Medicare covers swing bed services in certain hospitals and critical access hospitals 

(CAHs) when the hospital or CAH has entered into a “swing-bed” agreement with the 

Department of Health and Human Services.

Costs

When swing beds are used to furnish SNF-level care, the same coverage and costsharing rules apply as though the services were furnished in a SNF.

What it is

The facility can “swing” its beds and provide either acute hospital or skilled nursing 

facility (SNF)-level care, as needed. 

More information

Visit Medicare.gov/coverage/swing-bed-services.
Section 2: Items & services 95

Tdap shots 

Part A and Part B don’t cover the Tdap shot. Usually, Part D plans cover all 

commercially available vaccines needed to prevent illness.

What it is

Tdap is the adolescent and adult booster shot for tetanus, diphtheria, and pertussis 

(also called whooping cough). The childhood shot is called DTaP. Both protect against 

tetanus, diphtheria, and pertussis (whooping cough).

More information

• Contact your Medicare drug plan.

• Visit Medicare.gov/coverage/tdap-shots.

Telehealth 

Part B covers certain telehealth services.

Costs

You pay 20% of the Medicare-approved amount for your doctor or other health care 

provider’s services, and the Part B deductible applies. 

What it is

Telehealth services include office visits and consultations that are provided using an 

interactive 2-way telecommunications system (with real-time audio and video) by a 

doctor or certain other health care provider who isn’t at your location.

These services are available in some rural areas, under certain conditions, but only if 

the patient is located at one of these places: a doctor’s office, hospital, critical access 

hospital, rural health clinic, federally qualified health center, hospital-based or critical 

access hospital-based dialysis facility, skilled nursing facility, or community mental 

health center. 

More information

Visit Medicare.gov/coverage/telehealth.
96 Section 2: Items & services

Therapeutic shoes or inserts 

Part B covers the furnishing and fitting of either custom-molded shoes or inserts, or 

one pair of extra-depth shoes, if you have diabetes and severe diabetic foot disease.

Medicare also covers 2 additional pairs of inserts for custom-molded shoes and 3 pairs 

of inserts for extra-depth shoes. Medicare will cover shoe modifications instead of 

inserts.

How often

Each calendar year.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Things to know

The doctor who treats your diabetes must certify your need for therapeutic shoes or 

inserts. The shoes or inserts must be prescribed by a podiatrist (foot doctor) or other 

qualified doctor and provided by a podiatrist, orthotist, prosthetist, pedorthist, or 

other qualified individual.

More information

• Other diabetic services and supplies: See “Diabetes services” and “Diabetes 

supplies” on pages 30–31.

• Visit Medicare.gov/coverage/therapeutic-shoes-or-inserts.

Traction equipment 

Part B covers traction equipment that your doctor prescribes for use in your home. 

It’s covered as durable medical equipment (DME).

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/traction-equipment.
Section 2: Items & services 97

Transitional Care Management Services 

Medicare may cover these services if you’re returning to your community after a stay 

at certain facilities, like a hospital or skilled nursing facility. You’ll also be able to get an 

in-person office visit within 2 weeks of your return home.

Costs

You pay coinsurance and the Part B deductible.

Things to know

The health care provider who’s managing your transition back into the community will 

work to coordinate and manage your care for the first 30 days after you return home. 

They will work with you and your family and caregiver(s), as appropriate, and with your 

other health care providers.

The health care provider may also:

• Review information on the care you got in the facility

• Provide information to help you transition back to living at home

• Work with other care providers

• Help you with referrals or arrangements for follow-up care or community resources

• Help you with scheduling and managing your medications.

More information

Visit Medicare.gov/coverage/transitional-care-management-services.

Transplants 

Part B covers:

• Doctor’s services associated with heart, lung, kidney, pancreas, intestine, and liver 

organ transplants.

• Cornea transplants, in certain conditions.

• Immunosuppressive (or “transplant”) drugs, in certain conditions, associated with 

Medicare-covered transplants. 

Part A covers:

• Services for heart, lung, kidney, pancreas, intestine, and liver organ transplants, in 

certain conditions.

• Necessary tests, labs, and exams.

• Immunosuppressive (or “transplant”) drugs, in certain conditions, follow up care, 

and procurement of organs.

• Stem cell transplants, in certain conditions.
98 Section 2: Items & services

Transplants (continued) 

Costs

You pay: 

• 20% of the Medicare-approved amount for your doctor’s services, and the 

Part B deductible applies. 

• Various costs for transplant facility charges.

• Nothing for a living donor for a kidney transplant.

• Nothing for Medicare-certified laboratory tests. 

Things to know

Transplants must be performed in Medicare-approved facilities. Stem cell and cornea 

transplants aren’t limited to Medicare-approved transplant centers. 

More information

• Kidney transplants for adults: See “Kidney transplants” on pages 56–57.

• Kidney transplants for children: See “Kidney transplants (children)” on page 58.

• Pancreas transplants: See “Pancreas transplants” on page 74.

• Visit Medicare.gov/coverage/transplants.

Travel 

Medicare usually doesn’t cover health care while you’re traveling outside the U.S. 

There are some exceptions, including some cases where Part B may pay for services 

that you get on board a ship within the territorial waters adjoining the land areas of 

the U.S.

Medicare may pay for inpatient hospital, doctor, or ambulance services you get in a 

foreign country in these rare cases:

• You’re in the U.S. when an emergency occurs and the foreign hospital is closer 

than the nearest U.S. hospital that can treat your medical condition.

• You’re traveling through Canada without unreasonable delay by the most direct 

route between Alaska and another state when a medical emergency occurs and 

the Canadian hospital is closer than the nearest U.S. hospital that can treat the 

emergency.

• You live in the U.S. and the foreign hospital is closer to your home than the 

nearest U.S. hospital that can treat your medical condition, regardless of whether 

an emergency exists. 

Visit Medicare.gov/coverage/travel for more details.
Section 2: Items & services 99

Travel (continued) 

Costs

You pay 100% of the costs, in most cases. In the situations described on the previous 

page, you pay 20% of the Medicare-approved amount, and the Part B deductible 

applies. Visit Medicare.gov/coverage/travel for more cost information.

Things to know

The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, 

the Northern Mariana Islands, and American Samoa are considered part of the U.S.

More information

Visit Medicare.gov/coverage/travel.

Therapeutic continuous glucose monitors (CGMs) 

Medicare covers therapeutic CGMs and related supplies instead of blood sugar 

monitors for making diabetes treatment decisions, like changes in diet and insulin 

dosage.

If you use insulin and require frequent adjustments to your insulin regimen/dosage, 

a continuous glucose monitor may be covered if your doctor determines that you 

meet all of the requirements for Medicare coverage, including the need to frequently 

check your blood sugar (4 or more times a day) and the need to either use an insulin 

pump or receive 3 or more insulin injections per day. 

More information

• See “Diabetes services” & “Diabetes supplies”: on pages 30–31.

• See “Insulin”: on page 54.

• Visit Medicare.gov/coverage/therapeutic-continuous-glucose-monitors-cgms.
100 Section 2: Items & services

Urgently needed care 

Part B covers urgently needed care to treat a sudden illness or injury that isn’t a medical 

emergency.

Costs

You pay 20% of the Medicare-approved amount for your doctor or other health care 

provider’s services, and the Part B deductible applies. In a hospital outpatient setting, 

you also pay the hospital a copayment.

More information

Visit Medicare.gov/coverage/urgently-needed-care.

Vaccinations 

See “Shots” on page 91.

Vaginal cancer screenings 

See “Cervical & vaginal cancer screenings” on pages 17–18.

Walkers 

Medicare Part B covers walkers, including rollators, as durable medical equipment 

(DME). The walker must be medically necessary and prescribed by your doctor or 

other treating provider for use in your home.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/walkers.

Wheelchairs & scooters 

Medicare Part B covers power-operated vehicles (scooters) and manual wheelchairs as 

durable medical equipment (DME) that your doctor prescribes for use in your home.

You must have a face-to-face examination and a written prescription from a doctor 

or other treating provider before Medicare helps pay for a power wheelchair. Power 

wheelchairs are covered only when they’re medically necessary.

More information

• See “Durable medical equipment (DME)” on pages 36–38.

• Visit Medicare.gov/coverage/wheelchairs-scooters.
Section 2: Items & services 101

X-rays 

Part B covers medically necessary diagnostic X-rays.

Costs

You pay 20% of the Medicare-approved amount, and the Part B deductible applies. In a 

hospital outpatient setting, you pay a copayment.

Things to know

Your treating doctor or other health care provider must order the X-rays.

More information

• See “Diagnostic non-laboratory tests” on page 32.

• Visit Medicare.gov/coverage/x-rays.
102 Section 2: Items & services

Notice of Accessible Communications

To help ensure people with disabilities have an equal opportunity to participate in 

our services, activities, programs, and other benefits, we provide communications in 

accessible formats. The Centers for Medicare & Medicaid Services (CMS) provides 

auxiliary aids and services to help us better communicate with people with disabilities. 

Auxiliary aids include materials in Braille, audio/data CD or other accessible formats.

Note: You can get the “Medicare & You” handbook electronically in standard print, 

large print, or as an eBook.

For general Medicare inquiries and Medicare publications, call us at 1-800-MEDICARE 

(1-800-633-4227). TTY: 1-877-486-2048.

For all other CMS publications and documents in accessible formats, you can contact 

our Customer Accessibility Resource Staff:

Call 1-844-ALT-FORM (1-844-258-3676). TTY: 1-844-716-3676.

• Send a fax to 1-844-530-3676.

• Send an email to altformatrequest@cms.hhs.gov.

• Send a letter to:

Centers for Medicare & Medicaid Services

Offices of Hearings and Inquiries (OHI)

 7500 Security Boulevard, Mail Stop S1-13-25

Baltimore, MD 21244-1850

 Attn: Customer Accessibility Resource Staff

You can also contact the Customer Accessibility Resource staff:

• To inquire about a request for accessible formats.

• To submit concerns and issues about accessible communications, including the 

quality and timeliness of your request.

Note: Your request for a CMS publication or document should include:

• Your name, phone number, and the mailing address where we should send the 

publications or documents.

• The publication title and CMS Product No., if known.

• The format you need, like Braille, large print, or data/audio CD.

Note: If you’re enrolled in a Medicare Advantage or Medicare Prescription Drug Plan, 

you can contact your plan to request their documents in an accessible format.
103

Nondiscrimination Notice

CMS doesn’t exclude, deny benefits to, or otherwise discriminate against any person 

on the basis of race, color, national origin, disability, sex, or age in admission to, 

participation in, or receipt of the services and benefits under any of its programs and 

activities, whether carried out by CMS directly or through a contractor or any other 

entity with which CMS arranges to carry out its programs and activities.

How to file a complaint

If you believe you’ve been subjected to discrimination in a CMS program or activity, 

there are 3 ways to file a complaint with the U.S. Department of Health and Human 

Services, Office for Civil Rights:

1. Online at hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html.

2. By phone: Call 1-800-368-1019. TDD user can call 1-800-537-7697.

3. In writing: Send information about your complaint to:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

Paid for by the Department of Health & Human Services.
U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, Maryland 21244-1850

Official Business 

Penalty for Private Use, $300 

CMS Product No. 10116

Revised March 2019

Your Medicare Benefits

■ Medicare.gov 

■ 1-800-MEDICARE (1-800-633-4227) 

■ TTY: 1-877-486-2048 

¿ Necesita usted una copia en español? 

Llame GRATIS al 1-800-MEDICARE (1-800-633-4227).