This official government booklet has 

important information about the items and 

services Original Medicare covers.

Your

Medicare

Benefits

2 0 2 2
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 1-877-486-2048. 

“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.

If you have a question about a test, item, or service that isn’t listed in this 

booklet, visit Medicare.gov/coverage or call 1-800-MEDICARE 

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

If you have a Medicare Advantage Plan or other Medicare health plan, you 

have the same basic benefits as people who have Original Medicare, but each 

plan’s rules can vary. Some services and supplies may not be listed in this 

booklet because Medicare Advantage Plan 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 this booklet. 

They explain information that will be important in understanding 

Medicare Part A and Part B coverage. 

What’s the Part B deductible?

In 2022, you pay a yearly $233 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, what you pay may be higher if 

doctors, other health care providers, or suppliers don’t accept assignment. 

Although the Medicare-approved amount is lower for doctors who don’t 

accept assignment, they can charge you 15% over the Medicare-approved 

amount. This is called the “limiting charge.” The limiting charge only 

applies 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 Medicare-enrolled suppliers, 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 outof-pocket. It’s important to ask questions, so you understand why your doctor is 

recommending certain services and if 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, download and read the booklet “Medicare 

Appeals” at Medicare.gov/publications, or visit Medicare.gov/appeals.

What if an item or service isn’t listed in this booklet, 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 users can call 1-877-486-2048.

Can I get information on my mobile device?

To get Medicare coverage information on your smart phone or tablet, download 

Medicare’s free “What’s covered” mobile app on the App Store or Google Play.

Preventive services

Preventive services help you stay healthy. Throughout 

this booklet, you’ll see a picture of an apple next to 

preventive services 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 65–75 and have smoked at least 100 cigarettes in your lifetime. 

How often

Once in a lifetime.

Costs

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

provider accepts assignment.

Things to know

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

provider.

More information

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

Acupuncture 

Part B covers up to 12 acupuncture visits in 90 days for chronic low back pain.

Medicare covers an additional 8 sessions if you show improvement. If your 

doctor decides your chronic low back pain isn’t improving or is getting worse, 

Medicare won’t cover your additional treatments. You can get a maximum of 

20 acupuncture treatments in a 12-month period. 

Medicare doesn’t cover acupuncture (including dry needling) for any 

condition other than chronic low back pain.
8 Section 2: Items & services

Acupuncture (continued) 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

What it is

Acupuncture is a technique where providers stimulate specific points on the body, 

most often by inserting thin needles through the skin.

Things to know

Chronic low back pain is defined as:

• Lasting 12 weeks or longer

• Having no known cause (not related to cancer that has spread, or inflammatory 

or infectious disease)

• Having no association with surgery or pregnancy

You must get acupuncture from a doctor, or by another health care provider (like a 

nurse practitioner or physician assistant) who has both of these:

• A masters or doctoral level degree in acupuncture or Oriental Medicine from 

a school accredited by the Accreditation Commission on Acupuncture and 

Oriental Medicine.

• A current, full, active, and unrestricted license to practice acupuncture in the 

state where you’re getting care. 

More information

Visit Medicare.gov/coverage/acupuncture.

Advance care planning 

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

See “Preventive visits” on pages 98–99. 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 it’s given as part of your yearly “Wellness” visit. If it’s provided as 

part of your medical treatment, the Part B deductible and coinsurance apply.
Section 2: Items & services 9

Advance care planning (continued) 

What it is

This is planning for care you would get if you become unable to speak for yourself. As 

part of advance care planning, you may choose to complete an advance directive. This 

is an important legal document that records your wishes about medical treatment at 

a future time, if you aren’t able to make decisions about your care. You can talk about 

an advance directive with your health care provider, and they can help you fill out 

the forms, if you prefer. 

Things to know

Consider carefully who you want to speak for you and what direction you want 

to give. You shouldn’t feel forced to go against your values or preferences, and 

you have the right to carry out plans without discrimination based on your age or 

disability. For help with advance directives, visit the Eldercare Locator at 

eldercare.acl.gov. 

More information

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

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 provider 

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

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

How often

Medicare covers an alcohol misuse screening once each year. 

Costs

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

provider accepts assignment. 

Things to know

A qualified primary care doctor or other primary care provider must provide the 

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

More information

Visit Medicare.gov/coverage/alcohol-misuse-screenings-counseling.
10 Section 2: Items & services

Ambulance services 

Part B covers ground ambulance transportation when traveling in any other vehicle could 

endanger your health, and you need medically necessary services from a: 

• Hospital

• Critical access hospital, or 

• Skilled nursing facility 

Medicare may pay for emergency ambulance transportation in an airplane or helicopter if 

you need immediate and rapid transport 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 the transportation is 

medically necessary. For example, someone with End-Stage Renal Disease (ESRD) may need 

medically necessary ambulance transport to a kidney dialysis facility.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

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 

Ambulatory surgical centers are outpatient facilities that perform surgical procedures. In 

most cases, patients at ambulatory surgical centers are released within 24 hours. Part B 

covers facility service fees related to approved surgical procedures you get in these centers. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount to 

both the ambulatory surgical center and the doctor(s) who treat you. You pay nothing for 

certain preventive services (like a screening colonoscopy) if the doctor or other health care 

provider accepts assignment. However, you may have to pay other costs associated with 

the preventive services. For example, if your doctor removes a polyp during a screening 

colonoscopy, you may have to pay 20% of the Medicare-approved amount. You also pay all 

facility service fees for non-covered procedures you get in ambulatory surgical centers.
Section 2: Items & services 11

Ambulatory surgical centers (continued)

More information

• Visit Medicare.gov/coverage/ambulatory-surgical-centers. 

• To get cost estimates for ambulatory surgical center outpatient procedures, visit 

Medicare.gov/procedure-price-lookup.

Anesthesia 

Part A covers anesthesia services you get as an inpatient in a hospital. Part B covers 

anesthesia services you get as an outpatient in a hospital or a patient in a freestanding 

ambulatory surgical center. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for 

the anesthesia services you get from a doctor or certified registered nurse anesthetist. 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

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

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 predict your costs in advance. This is because you 

won’t know what services you need until you meet with your provider. If you need weight 

loss surgery or a procedure, you may be able to estimate how much you’ll have to pay. 

For help estimating costs on surgical procedures in certain settings, visit Medicare.gov/

procedure-price-lookup. 
12 Section 2: Items & services

Bariatric surgery (continued)

More information

Visit Medicare.gov/coverage/bariatric-surgery.

Barium enemas 

Part B covers this test if you’re 50 or older.

How often

Medicare covers the test once every 48 months if you’re 50 or older when your doctor 

uses it instead of a flexible sigmoidoscopy or colonoscopy. If you’re at high risk for 

colorectal cancer and are 50 or older, Medicare covers this test once every 24 months.

Costs

You pay 20% of the Medicare-approved amount for your doctor’s services. In a hospital 

outpatient setting, you also pay the hospital a copayment. The Part B deductible 

doesn’t apply.

What it is

An X-ray exam that can detect changes or abnormalities in your large intestine 

(colon). 

More information

Visit Medicare.gov/coverage/barium-enemas.

Behavioral health integration services 

Medicare may pay to help manage a behavioral health condition (like depression, 

anxiety, or another mental 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.
Section 2: Items & services 13

Behavioral health integration services (continued)

What it is

The Psychiatric Collaborative Care Model is a set of integrated behavioral health 

services, including care management support such as: 

• Care planning for behavioral health conditions

• Ongoing assessment of your condition

• Medication support

• Counseling

• Other treatments your provider recommends

Your health care provider will ask you to sign an agreement 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

Your provider may get blood from a blood bank at no charge. For more information, 

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

More information

Visit Medicare.gov/coverage/blood.

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

After you meet the Part B deductible, 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.
14 Section 2: Items & services

Blood-based biomarker tests 

Medicare covers a blood-based biomarker lab test if you meet all of these conditions:

• You’re between 50–85.

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

gastrointestinal pain, blood in stool, or 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

Medicare covers a blood-based biomarker test (if available) once every 3 years.

Costs

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

accepts assignment. 

More information

Visit Medicare.gov/coverage/colorectal-cancer-blood-based-biomarker-screenings.
Section 2: Items & services 15

Bone mass measurements 

Part B covers this test if you meet one or 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 find out if you’re at risk for broken bones.

More information

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

Braces (arm, leg, back, & neck) 

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

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

Things to know

If you live in or visit a competitive bidding area and need an off-the-shelf (OTS) back 

or knee brace, you generally must use specific suppliers called “contract suppliers,” if 

you want Medicare to help pay for the OTS brace. Contract suppliers must provide the 

brace to you and accept assignment as a term of their Medicare contract. 

Visit Medicare.gov/supplier to see if you live in or are visiting a competitive bidding 

area, or to find suppliers who accept assignment. You can also call 1-800-MEDICARE 

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

More information

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

Breast cancer screenings 

See “Mammograms” on page 71.

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.
Section 2: Items & services 17

Breast prostheses (continued) 

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

• Part A covers surgeries to implant breast prostheses in a hospital inpatient 

setting. See “Inpatient hospital care” on pages 61–63.

• Part B covers surgeries to implant breast prostheses in a hospital outpatient 

setting. See “Outpatient hospital services” on pages 85–86.

• Visit Medicare.gov/coverage/breast-prostheses.

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 42–44.

• Visit Medicare.gov/coverage/canes.

Cardiac rehabilitation 

Part B covers these comprehensive 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 programs that are usually more 

rigorous or intense than regular cardiac rehabilitation programs. Medicare covers 

these services in a doctor’s office or hospital outpatient setting (including a critical 

access hospital).
18 Section 2: Items & services

Cardiac rehabilitation (continued) 

Costs

You pay 20% of the Medicare-approved amount if you get these 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

Cardiac rehabilitation programs include exercise, education, and counseling if you’ve 

experienced a heart attack, heart failure or other heart problems as 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 qualified 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 primary care practitioner 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 on eating well.

More information

Visit Medicare.gov/coverage/cardiovascular-behavioral-therapy.
Section 2: Items & services 19

Cardiovascular disease screenings 

Part B covers blood tests that help detect cardiovascular disease. 

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

These screenings include blood tests for cholesterol, lipid, and triglyceride levels 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 48.

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 in most cases. 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 30-65 without HPV symptoms.
20 Section 2: Items & services

Cervical & vaginal cancer screenings (continued) 

Costs

If your doctor or other qualified health care provider accepts assignment, you pay 

nothing for the following:

• the lab Pap test

• the lab HPV with Pap test

• the Pap test specimen collection

• the pelvic and breast exams 

More information

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

Chemotherapy 

Medicare covers chemotherapy if you have cancer. Part A covers it if you’re a 

hospital inpatient. Part B covers it if you’re a hospital outpatient or get services in a 

doctor’s office or freestanding clinic. 

Costs

If you get Part B-covered chemotherapy in a hospital outpatient setting, you pay a 

copayment. For chemotherapy given in a doctor’s office or freestanding clinic, you 

pay 20% of the Medicare-approved amount after you meet the Part B deductible. 

More information

• Part A covers chemotherapy in a hospital inpatient setting. See “Inpatient 

hospital care” on pages 61–63.

• 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 38–39.

• Kidney transplants: See “Kidney transplants (children)” on page 68.

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

Coverage of Kidney Dialysis & Kidney Transplant Services.”
Section 2: Items & services 21

Chiropractic services 

Part B covers manual manipulation of the spine by a chiropractor or other qualified 

provider to correct a vertebral subluxation (when the spinal joints fail to move 

properly, but the contact between the joins remains intact). 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

Things to know

Medicare doesn’t cover other services or tests a chiropractor orders, including X-rays, 

massage therapy, and acupuncture (unless the acupuncture is for the treatment of 

chronic low back pain). 

More information

Visit Medicare.gov/coverage/chiropractic-services.

Chronic care management services 

If you have 2 or more serious chronic conditions (like arthritis and diabetes) that you 

expect to last at least a year, Medicare may pay for a health care provider’s help to 

manage those conditions.

Costs

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

supplemental insurance, including Medicaid, it may help cover the monthly fee.

What it is

Chronic care management includes a comprehensive care plan that lists your health 

problems and goals, other 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 chronic care management. 

If you agree to get this service, your provider 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. 
22 Section 2: Items & services

Chronic care management services (continued)

Things to know

To get started, ask your health care providers if they offer 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 tests when your doctor 

or provider orders them. 

Costs

You pay nothing for Medicare-approved clinical diagnostic laboratory tests.

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 

For certain qualifying clinical research studies, Part A and/or Part B cover some costs, 

like office visits and tests. 

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 different types of medical care, including new treatments, 

to find out how well they work and if they’re safe. For example, a clinical research study 

might test how well a new cancer drug works. 

More information

Visit Medicare.gov/coverage/clinical-research-studies.
Section 2: Items & services 23

Cognitive assessment & care plan services 

When you see your provider for a visit (including your yearly “Wellness” visit), they may 

perform a cognitive assessment to look for signs of dementia, including Alzheimer’s 

disease. Part B also covers a separate visit with your regular doctor or a specialist to fully 

review your cognitive function, establish or confirm a diagnosis like dementia (including 

Alzheimer’s disease), and establish a care plan.

Signs of cognitive impairment include trouble remembering, learning new things, 

concentrating, managing finances, or making decisions about your everyday life. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

What it is

During a cognitive assessment, your doctor may:

• Perform an exam, talk with you about your medical history, and review your 

medications.

• Create a care plan to help address and manage your symptoms.

• Help you develop or update your advance care plan.

• Refer you to a specialist, if needed.

• Help you understand more about community resources, like rehabilitation 

services, adult day health programs, and support groups. 

More information

Visit Medicare.gov/coverage/cognitive-assessment-care-plan-services.
24 Section 2: Items & services

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, Medicare covers the test once every 120 months, or 48 months 

after a previous flexible sigmoidoscopy. There’s no minimum age requirement.

Costs

If your doctor or other qualified health care provider accepts assignment, you pay 

nothing for a screening colonoscopy. 

However, if your doctor finds and removes a polyp or other tissue during the 

colonoscopy, you may pay 20% of the Medicare-approved amount of your doctor’s 

services and a separate facility copayment in a hospital outpatient setting. The Part B 

deductible doesn’t apply. 

More information

Visit Medicare.gov/coverage/colonoscopies.

Colorectal cancer screenings 

Part B may cover one or more of these screening tests:

• Barium enemas: See page 12.

• Blood-based biomarker tests: See page 14.

• Colonoscopies: See above.

• Fecal occult blood tests: See page 48.

• Flexible sigmoidoscopies: See page 49.

• Multi-target stool DNA tests: See pages 78–79. 

What it is

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

Commode chairs 

Part B covers commode chairs as durable medical equipment (DME) when your doctor 

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

More information

• See “Durable medical equipment (DME)” on pages 42–44.

• Visit Medicare.gov/coverage/commode-chairs.
Section 2: Items & services 25

Concierge care 

Medicare doesn’t cover membership fees for concierge care. 

Costs

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

What it is

Concierge care is when a doctor or group of doctors charges you a membership fee 

before they’ll see you or accept you into their practice. After you pay the membership 

fee, you may get some services or amenities that Medicare doesn’t cover.

Concierge care may also be called concierge medicine, retainer-based medicine, 

boutique medicine, platinum practice, or direct care. 

More information

Visit Medicare.gov/coverage/concierge-care.

Contact lenses 

See “Eyeglasses & contact lenses” on page 48.

Continuous glucose monitors 

If your doctor determines that you meet all the coverage requirements, Medicare 

covers continuous glucose monitors and related supplies for making diabetes 

treatment decisions (like changes in diet and insulin dosage). 

More information

• See “Diabetes services” & “Diabetes supplies” on pages 35–36.

• See “Insulin” on page 65.

• Visit Medicare.gov/coverage/therapeutic-continuous-glucose-monitors. 

Continuous Passive Motion (CPM) machines 

If you meet certain conditions, Medicare covers knee CPM machines as durable 

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

example, if you have knee replacement surgery, Medicare covers CPM machines for 

up to 21 days for use in your home. 

More information

• See “Durable medical equipment (DME)” on pages 42–44.

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

Continuous Positive Airway Pressure (CPAP) devices, 

accessories, & therapy 

Medicare may cover a 3-month trial of CPAP therapy (including devices and 

accessories) if you’ve been diagnosed with obstructive sleep apnea. After the trial 

period, Medicare may continue to cover CPAP therapy, devices and accessories if you 

meet with your doctor in person, and your doctor documents in your medical record 

that you meet certain conditions and the therapy is helping you. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount 

for the machine rental and purchase of related supplies (like masks and tubing).

What it is

CPAP therapy is an in-home treatment for people with sleep apnea.

Things to know

• If you had a CPAP machine before you got Medicare and you meet certain 

requirements, Medicare may cover a rental or replacement CPAP machine and/

or CPAP accessories.

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

been using it without interruption. After Medicare makes rental payments for 

13 continuous months, you’ll own the machine. 

More information

Visit Medicare.gov/coverage/continuous-positive-airway-pressure-devicesaccessories-therapy.

Cosmetic surgery 

Medicare usually doesn’t cover cosmetic surgery unless you need it 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 pages 16–17.

Costs

You pay 100% for non-covered services, including most cosmetic surgery.
Section 2: Items & services 27

Cosmetic surgery (continued) 

Things to know

Medicare requires prior authorization before you get these hospital outpatient 

services that are sometimes considered cosmetic:

• Blepharoplasty—Surgery on your eyelid to remove “droopy,” fatty, or excess tissue.

• Botulinum toxin injections (or “Botox”)—Injections used to treat muscle 

disorders, like spasms and twitches.

• Panniculectomy—Surgery to remove excess skin and tissue from your lower 

abdomen. 

• Rhinoplasty (or “nose job”)—Surgery to change the shape of your nose.

• Vein ablation—Surgery to close off veins.

If your procedure requires prior authorization before Medicare will pay for it, you 

don’t need to do anything. Your provider will send a prior authorization request 

and documentation to Medicare for approval before performing the procedure. If 

Medicare approves your prior authorization request, you should only need to pay 

your deductible and coinsurance.

More information

Visit Medicare.gov/coverage/cosmetic-surgery.

Counseling to prevent tobacco use & tobacco-caused disease 

If you use tobacco, Part B covers smoking and tobacco-use cessation counseling. 

How often

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

Costs

If your doctor or other qualified health care provider accepts assignment, you pay 

nothing for the counseling sessions.

What it is

Counseling to help you stop smoking or using tobacco. 

More information

Visit Medicare.gov/coverage/counseling-to-prevent-tobacco-use-tobacco-causeddisease.
28 Section 2: Items & services

COVID-19 antibody tests 

Part B covers FDA-authorized COVID-19 antibody tests (coverage could change 

when the public health emergency ends). 

Costs

You pay nothing for the antibody tests during the COVID-19 public health 

emergency.

What it is

These tests help see if you’ve developed an immune response to COVID-19.

More information

• For more information on other COVID-19 services: see “COVID-19 diagnostic 

tests” below, “COVID-19 monoclonal antibody treatments” on the next page,

and “COVID-19 vaccines” on page 30.

• Visit Medicare.gov/medicare-coronavirus.

• For more information on COVID-19, visit CDC.gov/coronavirus.

COVID-19 diagnostic tests 

Part B covers FDA-authorized COVID-19 diagnostic tests (coverage could change 

when the public health emergency ends). 

Costs

You pay nothing for a diagnostic test during the COVID-19 public health 

emergency when you get it from a laboratory, pharmacy, doctor, or hospital, and 

when Medicare covers this test in your local area.

What it is

These tests check to see if you have COVID-19.

More information

• For more information on other COVID-19 services: see “COVID-19 antibody 

tests” above, “COVID-19 monoclonal antibody treatments” on the next page, 

and “COVID-19 vaccines” on page 30.

• Visit Medicare.gov/medicare-coronavirus.

• For more information on COVID-19, visit CDC.gov/coronavirus.
Section 2: Items & services 29

COVID-19 monoclonal antibody treatments 

Part B covers FDA-authorized COVID-19 monoclonal antibody treatments. 

Costs

You pay nothing for a monoclonal antibody treatment during the COVID-19 public 

health emergency (and for the rest of the calendar year in which the COVID-19 

public health emergency ends) when you get it from a Medicare provider or 

supplier. You must meet certain conditions to qualify.

What it is

These treatments can help fight the disease and keep you out of the hospital, if you 

test positive for COVID-19 and have mild to moderate symptoms.

More information

• For more information on other COVID-19 services: see “COVID-19 antibody 

tests” on the previous page, “COVID-19 diagnostic tests” on the previous page, 

and “COVID-19 vaccines” on the next page.

• Visit Medicare.gov/medicare-coronavirus.

• For more information on COVID-19, visit CDC.gov/coronavirus.
30 Section 2: Items & services

COVID-19 vaccines 

Part B covers COVID-19 vaccines. 

Costs

You pay nothing for the vaccine, booster shot, or additional dose (if you’re 

immunocompromised).

What it is

Vaccines help reduced the risk of illness from COVID-19 by working with the 

body’s natural defenses to safely develop protection (immunity) to the virus.

Things to know

Bring your red, white, and blue Medicare card with you when you get the vaccine so 

your health care provider or pharmacy can bill Medicare. 

More information

• For more information on other COVID-19 services: see “COVID-19 antibody 

tests” on page 28, “COVID-19 diagnostic tests” on page 28, and “COVID-19 

monoclonal antibody treatments” on the previous page.

• Visit Medicare.gov/medicare-coronavirus.

• For more information on COVID-19, visit CDC.gov/coronavirus.
Section 1: Items & services 31

Crutches 

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

More information

• See “Durable medical equipment (DME)” on pages 42–44.

• Visit Medicare.gov/coverage/crutches.

CT scans 

See “Diagnostic non-laboratory tests” on page 37.

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

• Part A covers surgeries to implant defibrillators in the hospital inpatient 

setting. See “Inpatient hospital care” on pages 61–63.

• Visit Medicare.gov/coverage/defibrillators.
32 Section 2: Items & services

Dental services 

Medicare doesn’t cover most dental care (including procedures and 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 it doesn’t cover dental care.

Costs

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

More information

Visit Medicare.gov/coverage/dental-services.

Depression screenings 

Part B covers depression screenings to find out if you have symptoms of depression. 

How often

Once each year. 

Costs

If your doctor accepts assignment, you pay nothing for the screening. 

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.

If you or someone you know is in crisis, call the National Suicide Prevention 

Lifeline at 1-800-273-TALK (1-800-273-8255). TTY users can call 

1-800-799-4TTY (1-800-799-4889). You can call and speak with a counselor 24 

hours a day, 7 days a week. Call 911 if you’re in immediate medical crisis.
Section 2: Items & services 33

Diabetes screenings 

Part B covers glucose laboratory test screenings (with or without a carbohydrate 

challenge) if your doctor determines you’re at risk for developing diabetes. Part B 

covers these screenings if you have any of these risk factors:

• High blood pressure (hypertension)

• History of abnormal cholesterol and triglyceride levels (dyslipidemia)

• Obesity

• History of high blood sugar (glucose)

Part B also covers these screenings if 2 or more of these conditions apply to you:

• You’re 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 screenings if your doctor or other qualified health care 

provider accepts assignment. 

More information

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

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 in each calendar year that falls after the year you got your initial training. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount. 

What it is

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

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

prescription drugs, and reducing risks. Some patients may also be eligible for 

medical nutritional therapy training.

Things to know

To get DSMT, you must have a written order from your doctor or other qualified 

non-doctor provider.

Some exceptions apply if group sessions aren’t available in your area, or if your 

doctor or qualified non-doctor provider says you would benefit more from having 

individual training sessions.

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

Registered Dietitian) virtually through telehealth. See “Telehealth” on page 110.

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.
Section 2: Items & services 35

Diabetes services 

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

• Diabetes self-management training: See page 34.

• Eye exams (for diabetes): See page 47.

• Foot care (for diabetes): See page 51.

• Glaucoma tests: See page 52. 

• Nutrition therapy services: See page 80.

More information

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

Diabetes supplies 

Part B covers some diabetes supplies, including:

• Blood sugar (glucose) testing meters

• Blood sugar test strips

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

• Continuous glucose monitors and related supplies, like sensors

• Lancets and lancet holders

• Insulin and related supplies, like tubing, insertion sets, and pumps

• Therapeutic shoes or inserts

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 42–44.

Costs

If your supplier accepts assignment, you pay 20% of the Medicare-approved amount 

after you meet the Part B deductible.
36 Section 2: Items & services

Diabetes supplies (continued) 

Things to know

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

that isn’t used with an insulin pump, certain medical supplies used to inject insulin 

(like syringes, gauze, and alcohol swabs), and some oral diabetes drugs. Check with 

your plan for more information.

More information

• See “Durable medical equipment (DME)” on pages 42–44.

• Covered services if you have diabetes: See “Diabetes services” on page 35.

• Blood sugar monitors: Visit Medicare.gov/coverage/blood-sugar-meters. 

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

• Blood sugar control solutions: Visit Medicare.gov/coverage/glucose-controlsolutions. 

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

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

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

• Insulin: See page 65. 

• Therapeutic shoes or inserts: See pages 111–112. 
Section 2: Items & services 37

Diagnostic laboratory tests 

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

doctor or provider orders them. 

Costs

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

What it is

Diagnostic laboratory tests look for changes in your health and 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 or find a 

medical problem. For more information, see “Preventive & screening services” on 

pages 96–97. 

More information

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

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 to treat a medical problem. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount of covered diagnostic non-laboratory tests done in your doctor’s office or in 

an independent testing facility. You pay a copayment for diagnostic non-laboratory 

tests done in a hospital outpatient setting.

What it is

Tests 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 or find a 

medical problem. For more information, see “Preventive & screening services” on 

pages 96–97. 

More information

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

Dialysis (children) 

Part A and Part B cover different items and services for children’s (pediatric) 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-certified dialysis facility)

• Home dialysis equipment and supplies

• Certain home support services

• Most drugs for outpatient or home dialysis (like an erythropoiesis-stimulating 

agent to treat anemia)

• Doctors’ services 

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

• Dialysis when you travel and use a Medicare-certified facility

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 their kidneys no longer work.

• Your child has had a kidney transplant. 
Section 2: Items & services 39

Dialysis (children) (continued) 

Costs

• Inpatient hospital services: Part A pays for these services after you pay the 

hospital inpatient deductible.

• Doctors’ 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.

• Transportation services: 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 due to permanent kidney failure, Medicare 

coverage will end:

• 12 months after the last month of your child’s dialysis treatment

• 36 months after the month of your child’s kidney transplant

Medicare can extend coverage if your child meets certain conditions. 

More information

• See “Kidney transplants (children)” on page 68.

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

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

for Children with End-Stage Renal Disease.”
40 Section 2: Items & services

Dialysis services & supplies 

People with End-Stage Renal Disease (ESRD) have permanent kidney failure that 

requires dialysis or a kidney transplant. Medicare covers many kidney dialysis services 

and supplies if you have ESRD, including:

• Inpatient dialysis treatments: Part A covers dialysis if you’re admitted to a 

hospital for special care. See “Inpatient hospital care” on pages 61–63.

• Outpatient dialysis treatments & doctors’ services: Part B covers a variety of 

services in a Medicare-certified dialysis facility or your home. For example, 

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

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

related to your ESRD). Part B doesn’t cover ESRD-related drugs that are only 

available in an oral dosage form (drugs taken by mouth that only come in 

a capsule, tablet, or liquid form). Only Part D covers ESRD-related orally 

administered drugs.

• Home dialysis training: If you’re a candidate for home dialysis, Part B covers 

training for you and the person helping you with your home dialysis treatments. 

A Medicare-certified home dialysis training facility must provide the training. 

Only dialysis facilities can bill Medicare (directly or under arrangement) for 

providing home dialysis training.

• Home dialysis support services: Part B covers home dialysis support services 

you get from your dialysis facility. This may include visits by trained hospital 

or dialysis facility workers to check on your home dialysis, help in emergencies 

(when needed), and check your equipment and water supply.

• Home dialysis equipment & supplies: Part B covers home dialysis support 

services you get from your dialysis facility. This may include visits by trained 

hospital or dialysis facility workers to monitor your home dialysis, help in 

emergencies (when needed), and check your equipment and water supply.

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

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

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

disease.

• Other dialysis services & supplies: Part B covers other dialysis-related services 

and supplies (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 41

Dialysis services & supplies (continued) 

Costs

Visit Medicare.gov/coverage/dialysis-services-supplies for cost information.

Things to know

Medicare doesn’t cover:

• Paid dialysis aides to help you with home dialysis

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

training

• A place to stay during your treatment

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

More information

• See “Dialysis (children)” on pages 38–39.

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

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

Coverage of Kidney Dialysis & Kidney Transplant Services.”
42 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 & screening services” on pages 96–97. 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 Doctor of Chiropractic (DC).

Medicare also covers services you get from other health care providers, like:

• Physician assistants

• Nurse practitioners

• Clinical social workers

• Physical therapists

• Occupational therapists

• Speech-language pathologists

• Clinical psychologists

More information

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

Drugs 

See “Prescription drugs (outpatient)” on pages 93–96.

Durable medical equipment (DME) 

Part B covers medically necessary DME if your Medicare-enrolled doctor or other 

health care provider prescribes it for use in your home. You must rent most DME, 

but you can also buy some items. Some items become your property after making a 

certain number of payments. 
Section 2: Items & services 43

Durable medical equipment (DME) (continued) 

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

• Blood sugar meters and test strips

• Canes

• Commode chairs 

• Continuous passive motion machines 

• Continuous positive airway pressure (CPAP) devices

• Crutches 

• Hospital beds 

• Infusion pumps and supplies 

• Nebulizers and nebulizer medications 

• Oxygen equipment and accessories 

• Patient lifts

• Pressure-reducing support surfaces 

• Suction pumps 

• Traction equipment 

• Walkers

• Wheelchairs and scooters 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount for DME (if your supplier accepts assignment). Visit Medicare.gov/

coverage/durable-medical-equipment-dme-coverage for more cost information.

What it is

DME is defined as equipment that meets these criteria:

• Durable (can withstand repeated use)

• Used for a medical reason

• Typically only useful to someone who is sick or injured

• Used in your home

• Has an expected lifetime of at least 3 years
44 Section 2: Items & services

Durable medical equipment (DME) (continued) 

Things to know

Make sure your doctors and DME suppliers are enrolled in Medicare. It’s also 

important to ask a supplier if they participate in Medicare before you get DME. To 

get DME benefits, the doctor or supplier who gives you the DME must be enrolled 

in Medicare. If suppliers are participating in Medicare, they must accept assignment 

(which means they can charge you only the coinsurance and the Part B deductible 

for the Medicare-approved amount). If suppliers aren’t participating and don’t accept 

assignment, there’s no limit on the amount they can charge you. 

More information

• Visit Medicare.gov/coverage/durable-medical-equipment-dme-coverage.

• Visit Medicare.gov/publications to view the booklet, “Medicare Coverage of 

Durable Medical Equipment and Other Devices.”

E-visits 

Part B covers E-visits with your doctors and certain other providers.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount for your doctors’ services.

What it is

E-visits allow you to talk to your doctor using an online patient portal without going 

to the doctor’s office.

Providers who can give these services include:

• Doctors

• Nurse practitioners

• Physician assistants

• Licensed clinical social workers (in specific circumstances)

• Clinical psychologists (in specific circumstances)

• Physical therapists

• Occupational therapists

• Speech-language pathologists
Section 2: Items & services 45

E-visits (continued)

Things to know

You must talk to your doctor or other provider to start these types of visits.

More information

Visit Medicare.gov/coverage/e-visits.

Electrocardiogram (EKG or ECG) screenings 

Part B covers a routine EKG or ECG screening if you get a referral from your 

doctor or other health care provider during your one-time “Welcome to Medicare” 

preventive visit. Part B also covers EKGs or ECGs as diagnostic tests. 

How often

Once when you get a referral as part of your “Welcome to Medicare” visit, and more 

often as a diagnostic test if medically necessary. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved 

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

hospital a copayment.

More information

• See “Preventive visits” on pages 98–99.

• See “Diagnostic non-laboratory tests” on page 37.

• Visit Medicare.gov/coverage/ekg-or-ecg-screenings.
46 Section 2: Items & services

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 get. 

• After you meet the Part B deductible, you also pay 20% of the Medicare-approved 

amount for your doctor’s services. 

• If your doctor admits you 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 part of your inpatient stay. 

Things to know

Medicare only covers emergency services in foreign countries under rare 

circumstances. For more information, see “Travel outside the U.S.” on page 113.

More information

Visit Medicare.gov/coverage/emergency-department-services.

Enteral nutrition supplies & equipment 

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

prosthetic device benefit. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount. Medicare will cover your enteral infusion pump from a Medicare-enrolled 

doctor or supplier. If a supplier doesn’t accept assignment, there’s no limit on the 

amount they can charge you, and you may have to pay the entire bill (both your 

share and Medicare’s share) at the time you get the pump.

More information

• Visit Medicare.gov/coverage/enteral-nutrition-supplies-equipment.
Section 2: Items & services 47

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 52.

• Macular degeneration tests & treatment: See page 71. 

More information

Visit Medicare.gov/coverage/eye-exams.

Eye exams (for diabetes) 

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

be done by an eye doctor who’s legally allowed to do the test in your state. 

How often

Once each year. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount 

for your doctor’s services. In a hospital outpatient setting, you pay a copayment.

More information

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

supplies” on pages 35–36.

• 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.
48 Section 2: Items & services

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 that 

implants 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. 

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount 

for corrective lenses after each cataract surgery with an intraocular lens. 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.

Eyes 

See “Artificial eyes & limbs” on page 11. 

Fecal occult blood tests 

Medicare covers screening fecal occult blood tests if you get a referral from your doctor, 

physician assistant, nurse practitioner, or clinical nurse specialist.

How often

If you’re 50 or older, Medicare covers this lab test once every 12 months. If you’re under 

50, Medicare doesn’t cover this test. 

Costs

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

accepts assignment. 

More information

Visit Medicare.gov/coverage/fecal-occult-blood-tests.
Section 2: Items & services 49

Federally Qualified Health Center (FQHC) services 

FQHCs are public health centers that focus on serving at-risk and underserved 

populations, like those in urban and rural areas. 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. The Part B deductible doesn’t apply. All FQHCs offer 

discounts if your income is limited.

More information

• To find an 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 46. 

Flexible sigmoidoscopy screenings 

Medicare covers flexible sigmoidoscopy screenings (endoscopic procedures that 

examine the rectum and lower colon). 

How often

Medicare covers this test once every 48 months for most people age 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 you have a lesion or growth biopsied or removed during your screening, Medicare 

considers the procedure diagnostic and you may have to pay coinsurance and/or a 

copayment. In these cases, the Part B deductible doesn’t apply. 

More information

Visit Medicare.gov/coverage/flexible-sigmoidoscopies.
50 Section 2: Items & services

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.

Foot care 

Part B covers podiatrist (foot doctor) foot exams or treatment if you have diabetesrelated nerve damage that can increase the risk of limb loss, 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

• After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount for medically necessary treatment you get from your doctor. 

• 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 pages 111–112 and 

“Foot care (for diabetes)” on the next page. 

• Visit Medicare.gov/coverage/foot-care.
Section 2: Items & services 51

Foot care (for diabetes) 

Part B covers foot exams if you have diabetes-related lower leg nerve damage that can 

increase the risk of limb loss. 

How often

Once a year, as long as you haven’t seen a foot care professional for another reason 

between visits.

Costs

• After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount for any medically necessary foot treatment your doctor approves,. 

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

What it is

Depending on your exam results, foot care may include treatment for foot ulcers and 

calluses, and toenail management.

More information

• See “Therapeutic shoes or inserts” on pages 111–112. 

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

Foot care (routine) 

Medicare doesn’t usually cover routine foot care. 

Costs

In most cases, you pay 100% for routine foot care.

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 these tests if you’re at high risk for developing the eye disease glaucoma. 

You’re considered high risk if at least one of these conditions 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

• After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount.

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

Things to know

An eye doctor who’s legally allowed to do glaucoma tests in your state must do or 

supervise your screening.

More information

Visit Medicare.gov/coverage/glaucoma-tests.
Section 2: Items & services 53

Gym memberships & fitness programs 

Medicare doesn’t cover gym memberships or fitness programs.

Costs

You pay 100% for non-covered services, including gym memberships 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 & counseling: See page 9.

• Counseling to prevent tobacco use & tobacco-caused disease: See page 27.

• Depression screenings: See page 32.

• Diabetes self-management training: See page 34.

• Kidney disease education: See page 65.

• Medicare Diabetes Prevention Program: See pages 72–73.

• Nutrition therapy, if you have diabetes or kidney disease: See page 80.

• Obesity behavioral therapy: See page 81.

• A “Welcome to Medicare” preventive visit: See page 98.

• Yearly “Wellness” visits: See pages 98–99. 
54 Section 2: Items & services

Hearing & balance exams 

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

care provider orders them to find out if you need medical treatment. 

Costs

• After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount. 

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

More information

Visit Medicare.gov/coverage/hearing-balance-exams.

Hearing aids 

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

Costs

You pay 100% of the cost for hearing aids and exams.

More information

Visit Medicare.gov/coverage/hearing-aids.

Hepatitis B shots 

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

Your Hepatitis B risk increases if one or more of these conditions 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.
Section 2: Items & services 55

Hepatitis B shots (continued)

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

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

Costs

You pay nothing for Hepatitis B shots if your doctor or other qualified health care 

provider accepts assignment. 

More information

Visit Medicare.gov/coverage/hepatitis-b-shots.

Hepatitis B Virus (HBV) infection screenings 

Medicare covers an HBV screening if your primary care doctor orders one and you 

meet one of these conditions:

• You’re at high risk for HBV infection.

• You’re 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 

– At the time of delivery if you have 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 if your doctor or other qualified health care 

provider accepts assignment.

More information

Visit Medicare.gov/coverage/hepatitis-b-virus-infection-screenings. 
56 Section 2: Items & services

Hepatitis C screening tests 

Medicare covers a Hepatitis C screening test if your primary care doctor or other 

qualified health care provider orders one and you meet one or more of these 

conditions:

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

• You’re at high risk because you had a blood transfusion before 1992.

• You were born between 1945-1965. 

How often

Once, if you were born between 1945-1965 and aren’t considered high risk. If you’re 

at high risk (for example, you’ve continued to use illicit injection drugs since your 

previous negative Hepatitis C screening test), Medicare covers yearly screenings.

Costs

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

provider accepts assignment.

More information

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

HIV (Human Immunodeficiency Virus) screenings 

Part B covers an HIV screening if you meet one of these conditions:

• You’re 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 one of 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 57

Home health services 

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

How often

You can get skilled nursing and home health aide services up to 8 hours a day, with 

a maximum of 28 hours per week. You may be able to get more frequent care for a 

short time if your doctor determines it’s necessary.

Costs

• For all covered home health services, you pay nothing. 

• After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount 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 (only if you’re also getting 

skilled nursing care at the same time)

• Physical therapy

• Occupational therapy

• Speech-language pathology services

• Medical social services

• Injectable osteoporosis drugs for women (See “Osteoporosis drugs” on page 84.)

• Durable medical equipment

• Medical supplies for use at home

Medicare doesn’t pay for:

• 24-hour-a-day care at your home

• Meals delivered to your home

• Custodial or personal care that helps you with daily living activities (like 

bathing, dressing, and using the bathroom) when this is the only care you need

• Homemaker services (like shopping and cleaning) that aren’t related to your 

care plan

More information

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

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

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

Home infusion therapy services & supplies 

Part B covers home infusion equipment and supplies as durable medical equipment 

(DME) when used in your home.

Medicare also covers home infusion therapy services, like nursing visits, caregiver 

training, and patient monitoring.

Costs

You pay 20% of the Medicare-approved amount for home infusion therapy services, 

and for the equipment and supplies you use in your home. The Part B deductible 

applies for the equipment and supplies.

What it is

Home infusion supplies include pumps, IV poles, tubing, catheters, and certain 

infusion drugs. The professional services associated with home infusion therapy 

include the nursing services, training, education, and patient monitoring needed to 

administer certain intravenous or subcutaneous drugs safely in your home.

More information

• See “Durable medical equipment (DME)” on pages 42–44.

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

Hospice care 

You qualify for hospice care if you have Part A and meet all of these conditions:

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

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

treatments for your terminal illness and related conditions.

Costs

• You pay nothing for hospice care.

• You pay a copayment of up to $5 for each prescription for outpatient drugs for 

pain and symptom management. In the rare case the hospice benefit doesn’t 

cover your drug, your hospice provider should contact your plan to see if Part 

D covers it. The hospice provider will inform you if any drugs or services aren’t 

covered, and if you’ll be required to pay for them.

• You may pay 5% of the Medicare-approved amount for inpatient respite care.
Section 2: Items & services 59

Hospice care (continued) 

Costs

• You may have to pay for room and board if you live in a facility (like a nursing 

home) and choose to get hospice care.

What it is

Depending on your terminal illness and related conditions, your hospice team will 

create a plan of care that can include any or all of these services:

• Doctors’ services.

• Nursing care and medical services.

• Durable medical equipment for pain relief and symptom management.

• Medical supplies, like bandages or catheters.

• Drugs for pain management.

• Aide and homemaker services.

• Physical therapy services.

• Occupational therapy services.

• Speech-language pathology services.

• Social services.

• Dietary counseling.

• Spiritual and grief counseling for you and your family.

• Short-term inpatient care for pain and symptom management.

• Inpatient respite care, which is care you get in a Medicare-approved facility (like 

an inpatient facility, hospital, or nursing home), so that your usual caregiver (like a 

family member or friend) can rest. 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 only on an occasional basis.

• Any other services Medicare covers to manage your pain and other symptoms 

related to your terminal illness and related conditions, as your hospice team 

recommends.

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).
60 Section 2: Items & services

Hospice care (continued) 

Things to know

Medicare-certified hospice care is usually given in your home or other facility where 

you live, like a nursing home. 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

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

• See “Durable medical equipment (DME)” on pages 42–44.

Human Papillomavirus (HPV) tests 

See “Cervical & vaginal cancer screenings” on pages 19–20.

Humidifiers 

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

dehumidifiers, or electric air cleaners.

However, when medically necessary, Medicare covers oxygen humidifiers used with 

certain covered durable medical equipment (DME).

Costs

You pay 100% for most humidifiers or other similar items. If it’s medically necessary, 

you won’t have to pay a separate amount for an oxygen humidifier. The monthly fee 

for your oxygen equipment will include the cost of an oxygen humidifier.

More information

Visit Medicare.gov/coverage/humidifiers.
Section 2: Items & services 61

Hyperbaric oxygen therapy 

Medicare covers hyperbaric oxygen therapy, if you meet certain conditions and you get 

the therapy in a chamber (including a one-person unit). 

Costs

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

What it is

Hyperbaric oxygen therapy exposes your entire body to oxygen under increased 

atmospheric pressure.

More information

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

Inpatient hospital care 

Part A covers inpatient hospital care if you meet both of these conditions:

• 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, Part A also covers inpatient hospital care if the hospital’s Utilization 

Review Committee approves your stay while you’re admitted.
62 Section 2: Items & services

Inpatient hospital care (continued)

Costs

You pay this for each benefit period (in 2022):

• Days 1-60: $1,556 deductible.

• Days 61-90: $389 coinsurance each day.

• Days 91 and beyond: $778 coinsurance per each “lifetime reserve day” after 

day 90 for each benefit period (up to a maximum of 60 reserve days over your 

lifetime).

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

psychiatric hospital (but not in a Medicare-certified distinct part psychiatric unit 

of an acute care or critical access hospital) is limited to 190 days in a lifetime.

What it is

Medicare-covered inpatient hospital services include:

• Semi-private rooms

• Meals

• General nursing

• Drugs (including methadone to treat an opioid use disorder)

• Other hospital services and supplies as part of your inpatient treatment

Medicare doesn’t cover:

• Private-duty nursing

• A television or phone in your room (if there’s a separate charge for these items)

• Personal care items (like razors or slipper socks)

• A private room, unless medically necessary

Things to know

Inpatient hospital care includes care you get in:

• Acute care hospitals

• Critical access hospitals

• Inpatient rehabilitation facilities

• Long-term care hospitals

• Inpatient psychiatric facilities

It also includes inpatient care you get as part of a qualifying clinical research study. 

Part B covers the doctors’ services you get while you’re in a hospital.
Section 2: Items & services 63

Inpatient hospital care (continued)

More information

• Mental health care: See pages 74–77.

• Outpatient hospital services: See pages 85–86.

• Visit Medicare.gov/coverage/inpatient-hospital-care.

Inpatient rehabilitation care 

Part A covers medically necessary care you get in an inpatient rehabilitation facility 

or unit (sometimes called an inpatient “rehab” facility, IRF, acute care rehabilitation 

center, or rehabilitation hospital). Your doctor must certify that you have a medical 

condition that requires intensive rehabilitation, continued medical supervision, and 

coordinated care that comes from your doctors and therapists working together.

Costs

You pay this for each benefit period in 2022:

• Days 1-60: $1,556 deductible.*

• Days 61-90: $389 coinsurance each day.

• Days 91 and beyond: $778 coinsurance per each “lifetime reserve day” after 

day 90 for each benefit period (up to a maximum of 60 reserve days over your 

lifetime).

• Each day after the lifetime reserve days: All costs. 

*You don’t have to pay a deductible for inpatient rehabilitation care if you were 

already charged a deductible for care you got in a prior hospitalization within the 

same benefit period. This is because your benefit period starts on day one of your 

prior hospital stay, and that stay counts towards your deductible. For example you 

won’t have to pay a deductible for inpatient rehabilitation care if:

• You’re transferred to an inpatient rehabilitation facility directly from an acute 

care hospital.

• You’re admitted to an inpatient rehabilitation facility within 60 days of being 

discharged from a hospital.
64 Section 2: Items & services

Inpatient rehabilitation care (continued) 

What it is

Inpatient rehabilitation can help if you’re recovering from a serious surgery, illness, or 

injury, and need an intensive rehabilitation therapy program, physician supervision, 

and coordinated care from your doctors and therapists.

Medicare-covered inpatient rehabilitation care includes:

• Rehabilitation services, like physical therapy, occupational therapy, and 

speech-language pathology

• A semi-private room

• Meals

• Nursing services

• Prescription drugs

• Other hospital services and supplies

Medicare doesn’t cover:

• Private duty nursing

• A phone or television in your room (if there’s a separate charge for these items)

• Personal items, like toothpaste, socks, or razors (except when a hospital gives 

them as part of your hospital admission pack)

• A private room, unless medically necessary

Things to know

Part B covers doctors’ services you get while you’re in an inpatient rehabilitation facility.

More information

Visit Medicare.gov/coverage/inpatient-rehabilitation-care.
Section 2: Items & services 65

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 after you meet the Part B deductible). You pay 100% for 

syringes, needles, alcohol swabs, and gauze, unless you have Part D.

Things to know

Part D covers injectable insulin that’s not used with an insulin pump and certain 

medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs. However, 

if you use an external insulin pump, Part B may cover insulin used with the pump 

and the pump itself as durable medical equipment. See “Durable medical equipment 

(DME)” on pages 42–44.

You may be able to get Medicare drug coverage that offers savings on your insulin and costs 

you no more than $35 for a 30-day supply. Visit Medicare.gov/plan-compare to find a plan 

that offers this savings in your area.

More information

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

supplies” on pages 35–36.

• Visit Medicare.gov/coverage/insulin.

Kidney disease education 

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

IV chronic kidney disease that usually requires dialysis or a kidney transplant. Medicare 

covers this if your doctor or other health care provider refers you for the service, and 

when you get the service from a doctor, certain qualified non-doctor provider, or 

certain rural provider.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount 

per session if you get the service from a doctor or other qualified health care provider.

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. 

More information

Visit Medicare.gov/coverage/kidney-disease-education.
66 Section 2: Items & services

Kidney services & supplies 

See “Dialysis services & supplies” on pages 40–41.

Kidney transplants 

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

Medicare covers these services if they’re done by the Medicare-certified hospital 

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

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

• Inpatient services in a Medicare-certified hospital

• A kidney registration fee

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

of potential kidney donors

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

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

surgery

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

processing and giving you blood)

Part A also covers the full cost of care for your kidney donor (including care before 

surgery, the actual surgery, and care after surgery)

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

• 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 your kidney transplant if both of these apply:

• You’re only eligible for Medicare because of permanent kidney failure.

• You have a pancreas transplant after your kidney transplant.
Section 2: Items & services 67

Kidney transplants (continued) 

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

transplant if you only have Medicare because of permanent kidney failure. 

Medicare will continue to pay for your transplant drugs with no time limit if either of 

these apply:

• You were already eligible for Medicare because of age or disability before you got 

End-Stage Renal Disease (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 to the living donor for a kidney transplant

• Nothing for Medicare-approved laboratory tests

More information

• See “Organ transplants” on page 83.

• 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.”
68 Section 2: Items & services

Kidney transplants (children) 

Part A and Part B cover different items and services related to children’s (pediatric) 

kidney transplants.

Part A usually covers these transplant services:

• Inpatient services in an approved hospital

• Kidney registry fee

• Laboratory and other tests 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 their hospital stay

• Transplant drugs, usually 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, after you pay a one-time 

yearly deductible.

• Part B usually pays 80% of the Medicare-approved amount for services, after you 

pay the Part B yearly deductible. You pay the remaining 20% coinsurance. 

• For Part B-covered dialysis services, your costs will vary based on your child’s 

age and dialysis type. 

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

More information

• See “Dialysis (children)” on pages 38–39.

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

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

for Children with End-Stage Renal Disease.”
Section 2: Items & services 69

Laboratory tests 

• Clinical laboratory tests: See page 22.

• Diagnostic laboratory tests: See page 37.

• Diagnostic non-laboratory tests: See page 37. 

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, which is care that helps you 

with daily living activities (like bathing, dressing, and using the bathroom).

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 helps 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. 

Costs

You pay this for each benefit period in 2022:

• Days 1-60: $1,556 deductible.*

• Days 61-90: $389 coinsurance each day.

• Days 91 and beyond: $778 coinsurance per each “lifetime reserve day” after 

day 90 for each benefit period (up to a maximum of 60 reserve days over your 

lifetime).

• Each day after the lifetime reserve days: All costs.

*You don’t have to pay a deductible for care you get in the long-term care hospital 

if you were already charged a deductible for care you got in a prior hospitalization 

within the same benefit period. This is because your benefit period starts on day one 

of your prior hospital stay, and that stay counts towards your deductible. For example, 

you won’t have to pay a deductible for your long-term care hospital care if:

• You’re transferred there directly from an acute care hospital.

• You’re admitted within 60 days of being discharged from a hospital. 
70 Section 2: Items & services

Long-term care hospital services (continued) 

What it is

Long-term care hospitals provide care to patients with more than one serious medical 

condition. The patients may improve with time and care, and eventually return home. 

Long-term care hospitals typically give services like respiratory therapy, head trauma 

treatment, and pain management. 

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 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 each year.

Costs

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

Things to know

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

and shared decision-making visit with your doctor. During your visit, you and your 

doctor will discuss the benefits and risks of lung cancer screenings, and decide 

whether a screening is right for you.

More information

Visit Medicare.gov/coverage/lung-cancer-screenings.
Section 2: Items & services 71

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.

Costs

• After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount for the drug and your doctor’s services. 

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

More information

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

Mammograms 

Part B covers:

• A baseline mammogram (if you’re a woman between 35–39)

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

• Diagnostic mammograms 

How often

• Baseline mammogram: Once in your lifetime.

• 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: After you meet the Part B deductible, you pay 20% of 

the Medicare-approved amount.

What it is

Mammograms are screenings that check for breast cancer.

More information

Visit Medicare.gov/coverage/mammograms.
72 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.

Medicare Diabetes Prevention Program 

Part B covers the Medicare Diabetes Prevention Program if all of these conditions 

apply to you:

• Within 12 months before attending your first core session, 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).

• 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 in a lifetime.

Costs

You pay nothing for this program if you’re eligible.
Section 2: Items & services 73

What it is

The Medicare Diabetes Prevention Program is a proven health behavior change 

program to help prevent type 2 diabetes.

The program begins with weekly 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 around diet and exercise

• Tips on how to get more exercise

• Strategies for controlling your weight

• A specially trained coach to help keep you motivated

• Support from people with similar goals and challenges

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

• 6 monthly follow-up sessions to help you maintain healthy habits

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

weight loss and attendance goals

Things to know

To see if there’s a Medicare Diabetes Prevention Program supplier in your area, visit 

Medicare.gov/talk-to-someone.

More information

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

Mental health care (inpatient) 

Part A covers mental health care services you get when you’re admitted as a hospital 

inpatient.

Costs

You pay this for each benefit period in 2022:

• $1,556 deductible.

• Days 1–60: $0 coinsurance each day. 

• Days 61–90: $389 coinsurance each day. 

• Days 91 and beyond: $778 coinsurance per each “lifetime reserve day” after 

day 90 for each benefit period (up to a maximum of 60 reserve days over your 

lifetime).

• Each day after the 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 care services involve diagnosing and treating people with mental health 

disorders, like depression and anxiety.

Things to know

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

facility that only cares for people with mental health disorders).

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 75

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 outpatient mental health services:

• One depression screening each 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 32.

• Individual and group psychotherapy with doctors (or with certain other licensed 

professionals, as the state where you get the services allows).

• 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 page 77.

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

your possible risk factors for depression. See “Preventive visits” on pages 98–99.

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

changes in your mental health since your last visit. See “Preventive visits” on 

pages 98–99.

Part B also covers outpatient mental health services as part of substance abuse 

treatment.
76 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.

• You pay 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 involve diagnosing and treating people with mental health 

disorders, 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

• Physician assistants

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

provided outside a hospital, in these types of settings: 

• A doctor’s or other health care provider’s office

• A hospital outpatient department

• 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 77

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 professional if they accept 

assignment.

• After you meet the Part B deductible, you also pay coinsurance for each day 

of partial hospitalization services you get in a hospital outpatient setting or 

community mental health center.

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. You get this treatment during the day, and you don’t have to stay 

overnight. Medicare helps cover partial hospitalization services you get through a hospital 

outpatient department or community mental health center.

Things to know

As part of 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.
78 Section 2: Items & services

Mental health & substance use disorder services 

Medicare covers certain screenings, services, and programs that aid in the treatment 

and recovery of mental health and substance use disorders, including:

• Alcohol misuse screenings: See page 9.

• Behavioral health integration services: See pages 12–13.

• Counseling to prevent tobacco use & tobacco-caused disease: See page 27.

• Depression screenings: See page 32.

• Mental health care: See pages 74–77.

• Opioid use disorder treatment services: See page 82.

• Telehealth: See page 110.

Multi-target stool DNA tests 

Medicare covers at-home multi-target stool DNA tests if you meet all these 

conditions:

• You’re between 50–85.

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

gastrointestinal pain, blood in stool, or 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.
Section 2: Items & services 79

Multi-target stool DNA tests (continued)

Costs

You pay nothing for these tests 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 37.

Nebulizers & nebulizer medications 

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

reasonable and necessary). Part B covers these as durable medical equipment (DME) 

that your doctor prescribes for use in your home.

More information

• See “Durable medical equipment (DME)” on pages 42–44.

• 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, which 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.”
80 Section 2: Items & services

Nutrition therapy services 

Part B may cover medical nutrition therapy services and certain related services if 

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

36 months.

Costs

You pay nothing for these preventive services if you qualify to get them.

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

Only a Registered Dietitian (or other nutrition professional who meets certain 

requirements) can provide medical nutrition services, but your doctor can refer you 

for the service.

If you get dialysis in a dialysis facility, Medicare covers medical nutrition therapy as 

part of your overall dialysis care.

If you’re in a rural area, a Registered Dietitian or other nutrition professional in a 

different location may be able to provide medical nutrition therapy to you through 

telehealth. 

See “Telehealth” on page 110.

More information

Visit Medicare.gov/coverage/nutrition-therapy-services.
Section 2: Items & services 81

Obesity behavioral therapy 

Medicare covers obesity screenings and behavioral counseling if you have a body 

mass index (BMI) of 30 or more. Medicare covers this counseling if your primary care 

doctor or other qualified practitioner gives the counseling in a primary care setting 

(like a doctor’s office), where they can coordinate your personalized prevention plan 

with your other care. 

Costs

You pay nothing for this service if your primary care doctor or other qualified 

primary care practitioner accepts assignment.

What it is

Obesity behavioral therapy includes 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.

More information

Visit Medicare.gov/coverage/obesity-behavioral-therapy.

Observation services 

See “Outpatient hospital services” on pages 85–86. 

Occupational therapy 

Part B helps pay for medically necessary outpatient occupational therapy if your 

doctor or other health care provider certifies you need it.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

What it is

Therapy to help you perform activities of daily living (like dressing or bathing). When 

your doctor or other health care provider certifies you need it, this therapy helps to 

improve or maintain current capabilities, or slow decline. 

Things to know

There’s no limit on how much Medicare pays for your medically necessary outpatient 

occupational therapy services in one calendar year.

More information

Visit Medicare.gov/coverage/occupational-therapy.
82 Section 2: Items & services

Opioid use disorder treatment services 

Part B covers opioid use disorder treatment services in opioid treatment programs.

Costs

You won’t have to pay any copayments for these services if you get them from an 

opioid treatment program provider who’s enrolled in Medicare. However, the 

Part B deductible still applies. Medicare pays doctors and other providers for officebased opioid use disorder treatment, including management, care coordination, 

psychotherapy, and counseling activities. 

What it is

These services, which help people recover from opioid use disorder, include: 

• Medication (like methadone, buprenorphine, naltrexone, and naloxone)

• Counseling

• Drug testing

• Individual and group therapy

• Intake activities

• Periodic assessments 

Medicare covers counseling, therapy, and periodic assessments both in person and 

by virtual delivery (using audio and video communication technology, like your 

phone or a computer).

Things to know

Talk to your doctor or other health care provider to find out where you can go for 

these services. You can also visit Medicare.gov/talk-to-someone and select “Opioid 

Treatment Program Services” to find a program near you.

Medicare Advantage Plans must also cover opioid treatment program services. 

If you’re in a Medicare Advantage Plan, your current opioid treatment program 

must be Medicare-enrolled to make sure your treatment stays uninterrupted. If 

not, you may have to switch to a Medicare-enrolled opioid treatment program. 

Since Medicare Advantage Plans are able to apply copayments to opioid treatment 

program services, you should check with your plan to see if you have to pay a 

copayment.

More information

Visit Medicare.gov/coverage/opioid-use-disorder-treatment-services.
Section 2: Items & services 83

Organ transplants 

Part B covers:

• Doctors’ services associated with heart, lung, kidney, pancreas, intestine, and 

liver organ transplants

Under certain conditions, Part B also covers:

• Bone marrow transplants

• Cornea transplants

• Immunosuppressive (or “transplant”) drugs associated with Medicare-covered 

transplants

Part A covers:

• Necessary tests, labs, and exams

Under certain conditions, Part A also covers:

• Services for heart, lung, kidney, pancreas, intestine, and liver organ transplants

• Immunosuppressive (or “transplant”) drugs, follow up care, and procurement 

of organs

• Stem cell transplants

Costs

You pay:

• 20% of the Medicare-approved amount for your doctor’s services after you 

meet the Part B deductible.

• Various costs for transplant facility charges.

• Nothing to the living donor for a kidney transplant.

• Nothing for Medicare-certified laboratory tests.

Things to know

You must get an organ transplant in a Medicare-approved facility. Stem cell and 

cornea transplants aren’t limited to Medicare-approved transplant centers.

More information

• Kidney transplants for adults: See “Kidney transplants” on pages 66–67.

• Kidney transplants for children: See “Kidney transplants (children)” 

on page 68.

• Pancreas transplants: See “Pancreas transplants” on page 90.

• Visit Medicare.gov/coverage/organ-transplants.
84 Section 2: Items & services

Orthopedic shoes 

Medicare covers orthopedic shoes if they’re a necessary part of a leg brace.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

Things to know

For Medicare to cover your orthopedic shoes, you must go to a Medicare-enrolled 

supplier. Medicare will only pay for orthotic items from a Medicare-enrolled supplier, 

no matter who submits the claim (you or your supplier).

More information

• See “Therapeutic shoes or inserts” on pages 111–112.

• Visit Medicare.gov/coverage/orthopedic-shoes.

Osteoporosis drugs 

Part A and Part B help pay for an osteoporosis injectable drug 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 57.

• 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 or caregivers are unable and unwilling to 

give you the drug by injection.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount 

for the cost of the drug. You pay nothing for the home health nurse visit to inject the 

drug. 

More information

• Home health services: See page 57.

• Visit Medicare.gov/coverage/osteoporosis-drugs.
Section 2: Items & services 85

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

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount 

for your doctor’s services and supplies. 

Things to know

Medicare covers these supplies as prosthetic devices.

More information

Visit Medicare.gov/coverage/ostomy-supplies.

Outpatient hospital services 

Part B covers many 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 77.

• X-rays and other radiology services billed by the hospital.

• Medical supplies, like splints and casts.

• Preventive and screening services. See pages 96–97.

• Certain drugs and biologicals that you wouldn’t usually give yourself that you get 

as part of your service or procedure (like certain injectable drugs). 
86 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. 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. 

• To get cost estimates for outpatient hospital procedures, visit 

Medicare.gov/procedure-price-lookup.

Outpatient medical & surgical services & supplies 

Part B covers approved outpatient services and supplies, like X-rays, casts, stitches, or 

outpatient surgeries. 

Costs

You pay 20% of the Medicare-approved amount for doctor or other health care provider 

services. You also generally pay a copayment for each service you get in a hospital 

outpatient setting. In most cases, the copayment can’t be more than the Part A hospital 

stay deductible for each service you get. 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 87

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 aren’t 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

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

More information

• See “Durable medical equipment (DME)” on pages 42–44.

• Visit Medicare.gov/coverage/oxygen-equipment-accessories.
88 Section 2: Items & services

Pain management 

Part B helps pay for these services that may help you manage your pain and related 

issues:

• Behavioral health integration services. See pages 12–13.

• Physical therapy. See page 91.

• Occupational therapy. See page 81.

• Chiropractic services. See page 21.

• Alcohol misuse screenings & counseling. See page 9.

• Depression screenings. See page 32.

• Acupuncture for chronic low back pain. See pages 7–8.

If you have a Medicare drug plan, the plan may also have programs in place (like 

Medication Therapy Management programs or Drug Management programs) to help 

you use prescription opioid pain medications more safely. Visit Medicare.gov/drugcoverage-part-d/what-drug-plans-cover/medication-therapy-management-programsfor-complex-health-needs for more information.

Costs

• For most pain management services, you pay 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.

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

provider accepts assignment.
Section 2: Items & services 89

Pain management (continued) 

Things to know

There may be other ways to manage your pain. Your doctor may recommend 

treatment options that Medicare doesn’t cover, like massage therapy. 

If this happens, or if your doctor or other health care provider recommends you get 

services more often than Medicare covers, you may have to pay some or all of the 

costs. Ask questions so you understand why your doctor is recommending certain 

services and if Medicare will pay for them.

More information

Visit Medicare.gov/coverage/pain-management.
90 Section 2: Items & services

Pancreas transplants 

Medicare covers pancreas transplants under certain conditions. If you have 

End-Stage 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 also 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 already eligible for Medicare because of age or disability before you 

got your transplant.

• 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 your kidney transplant if both of these apply:

• You’re only eligible for Medicare because of permanent kidney failure.

• You have your pancreas transplant after a kidney transplant.

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

transplant if you only have Medicare because of permanent kidney failure.

Costs

You pay:

• 20% of the Medicare-approved amount for doctors’ services.

• Various amounts for transplant facility charges. 

• Nothing for Medicare-approved laboratory tests. 

More information

• Other types of Medicare-covered transplants: See “Organ transplants” 

on page 83.

• Visit Medicare.gov/coverage/pancreas-transplants.
Section 2: Items & services 91

Pap tests 

See “Cervical & vaginal cancer screenings” on pages 19–20.

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 42–44.

• Visit Medicare.gov/coverage/patient-lifts. 

PET scans 

See “Diagnostic non-laboratory tests” on page 37.

Physical therapy 

Part B covers evaluation and treatment for injuries and diseases that change your 

ability to function, or to improve or maintain current function or slow decline, when 

your doctor or other health care provider certifies you need it. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

Things to know

There’s no limit on how much Medicare pays for your medically necessary outpatient 

physical therapy services in one calendar year.

More information

Visit Medicare.gov/coverage/physical-therapy. 

Power wheelchairs

See “Wheelchairs & scooters” on page 116.
92 Section 2: Items & services

Pneumococcal shots 

Part B covers 2 different pneumococcal shots to help protect against different types of 

pneumonia. 

How often

Part B covers the first pneumococcal 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 shots. 

What it is

The 2 shots protect against different strains of the bacteria that cause pneumonia.

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 93

Prescription drugs (outpatient) 

Part B covers a limited number of outpatient prescription drugs under certain 

conditions.

Usually, Part B covers drugs you wouldn’t typically give to yourself, like those you get 

at a doctor’s office or in a hospital outpatient setting.

Here are some examples of Part B-covered drugs:

• 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, if the drug used with the pump is reasonable and necessary.

• Some antigens: Medicare helps pay for antigens if a doctor prepares them and 

they’re given by a properly instructed person (who could be you, the patient) 

under appropriate supervision.

• Injectable osteoporosis drugs: Medicare helps pay for injectable osteoporosis 

drugs if you meet all of these conditions:

– You’re a woman with osteoporosis who meets the criteria for the Medicare 

home health benefit.

– You have a bone fracture that a doctor certifies was related to postmenopausal osteoporosis. 

– Your doctor certifies that you can’t give yourself the injection or learn how 

to give yourself the drug by injection. 

In addition, Medicare will cover the home health nurse or aide to provide the 

injection if your 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 injectable and infused 

drugs when a licensed medical provider gives them, because these types of drugs 

aren’t usually self-administered.

• 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 Part B ESRD 

benefit covers it.
94 Section 2: Items & services

Prescription drugs (outpatient) (continued) 

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.

• Parenteral and enteral 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, and your 

doctor decides that it’s medically appropriate for you to get the IVIG in your 

home. Part B covers the IVIG itself, but 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 or illness.

• Transplant/immunosuppressive drugs: Medicare covers transplant drug 

therapy if Medicare helped pay for your organ transplant. 

Part D covers transplant drugs that Part B doesn’t cover. If you have Original 

Medicare, you may join a Medicare drug plan to get Medicare drug coverage 

(Part D).

If you’re entitled to Medicare only because of ESRD, your Medicare coverage, 

including transplant drug therapy, ends 36 months after the month of your 

kidney transplant.

However, if you’re entitled to Medicare because of your age or disability, 

Medicare will continue to pay for your transplant drugs with no time limit as 

long as either Medicare paid for your transplant, or your private insurance paid 

for your transplant (and that insurance was the primary payer ahead of your 

Part A coverage).

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 95

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. If Part B 

doesn’t cover them, Part D does.

• Oral anti-nausea drugs: Medicare helps pay for oral anti-nausea drugs you 

use 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 settings: Medicare may pay 

for some self-administered drugs if you need them for the hospital outpatient 

services you’re getting.

Costs

Doctors and pharmacies must accept assignment for Part B-covered drugs, so you 

should never be asked to pay more than the coinsurance or copayment for the 

Part B-covered drug itself. In most cases, after you meet the Part B deductible, you 

pay 20% of the Medicare-approved amount for Part B-covered prescription drugs 

that you get in a doctor’s office or pharmacy. 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. 

If you get prescription drugs that Part B doesn’t cover in a hospital outpatient setting, 

you pay 100% for the drugs, unless you have Medicare drug coverage (Part D) or 

other drug coverage. In that case, what you pay depends on whether your drug plan 

covers the drug, and whether the hospital is in your plan’s network. Contact your 

plan to find out what you pay if you get drugs in a hospital outpatient setting that 

Part B doesn’t cover.

You pay nothing (and the Part B deductible doesn’t apply) for flu, pneumococcal, and 

Hepatitis B shots. 
96 Section 2: Items & services

Prescription drugs (outpatient) (continued) 

Things to know

Medicare drug coverage (Part D) covers drugs Part B doesn’t cover. If you have drug 

coverage, check your plan’s drug list (also called a formulary) to see what outpatient 

drugs it covers.

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,” if you have Part D.

Pressure-reducing support surfaces 

Part B covers pressure-reducing support surfaces as durable medical equipment 

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

Note: If you live in certain states, you may have to get prior approval for 5 types of 

pressure-reducing support surfaces.

What it is

Pressure-reducing support surfaces include certain beds (like air-fluidized beds), 

mattresses, and mattress overlays.

More information

• See “Durable medical equipment (DME)” on pages 42–44.

• Visit Medicare.gov/coverage/pressure-reducing-support-surfaces.

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

Authorization for Certain Types of Pressure-Reducing Support Surfaces.”

Preventive & screening services 

Part B covers many preventive and screening 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, detect health problems early, determine 

the most effective treatments, and prevent 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. 
Section 2: Items & services 97

Preventive & screening services (continued) 

Here’s a list of preventive and screening services Part B covers:

• Abdominal aortic aneurysm screenings: See page 7.

• Alcohol misuse screenings & counseling: See page 9.

• Blood-based biomarker tests: See page 14.

• Cardiovascular behavioral therapy: See page 18.

• Cardiovascular disease screenings: See page 19.

• Cervical & vaginal cancer screenings: See pages 19–20.

• Colorectal cancer screenings: See page 24.

• Counseling to prevent tobacco use & tobacco-caused disease: See page 27.

• Depression screenings: See page 32.

• Diabetes screenings: See page 33.

• Diabetes self-management training: See page 34.

• Glaucoma tests: See page 52.

• Hepatitis B Virus infection screenings: See page 55.

• Hepatitis C screening tests: See page 56.

• HIV screenings: See page 56.

• Lung cancer screenings: See page 70.

• Mammograms: See page 71.

• Medicare Diabetes Prevention Program: See pages 72–73. 

• Nutrition therapy services: See page 80.

• Obesity behavioral therapy: See page 81.

• Preventive visits: See pages 98–99.

• Prostate cancer screenings: See pages 99–100.

• Sexually transmitted infection (STI) screening & counseling: See pages 104–105.

• Shots (or vaccines): See page 105. 

More information

Visit Medicare.gov/coverage/preventive-screening-services.
98 Section 2: Items & services

Preventive visits 

“Welcome to Medicare” preventive visit

Part B covers a “Welcome to Medicare” preventive visit. 

How often

Once. You must have this 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 that 

Medicare doesn’t cover under this preventive benefit.

What it is

This visit includes a review of your medical and social history related to your health. 

It also includes education and counseling about preventive services, including certain 

screenings, shots or vaccines (like flu, pneumococcal, and other recommended shots 

or vaccines), and referrals for other care, if needed.

If you have a current prescription for opioids, your provider will review your potential 

risk factors for opioid use disorder, evaluate your severity of pain and current 

treatment plan, provide information on non-opioid treatment options, and may refer 

you to a specialist, if appropriate. Your provider will also review your potential risk 

factors for substance use disorder and refer you for treatment, if needed.

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 your personalized plan to help prevent disease and disability, based 

on your current health and risk factors. Your provider will also perform a cognitive 

impairment assessment. The yearly “Wellness” visit isn’t a physical exam. 
Section 2: Items & services 99

Preventive visits (continued)

How often

Once every 12 months. Your first yearly “Wellness” visit can’t take place within 12 

months of your Part B enrollment or your “Welcome to Medicare” preventive visit. 

However, you don’t need to have had a “Welcome to Medicare” preventive visit to 

qualify for a yearly “Wellness” visit.

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 that Medicare 

doesn’t cover under this preventive benefit. If Medicare doesn’t cover the additional 

tests or services (like a routine physical exam), you may have to pay the full amount.

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. Your provider will also perform a cognitive impairment assessment to look 

for signs of dementia, including Alzheimer’s disease. Signs of cognitive impairment 

include trouble remembering, learning new things, concentrating, managing finances, 

and making decisions about your everyday life. If your provider thinks you may have 

cognitive impairment, Medicare covers a separate visit to do a more thorough review of 

your cognitive function and check for conditions like dementia, depression, anxiety, or 

delirium. See page 23. Your provider may order other tests, if necessary, depending on 

your general health and medical history. 

If you have a current prescription for opioids, your provider will review your potential 

risk factors for opioid use disorder, evaluate your severity of pain and current treatment 

plan, provide information on non-opioid treatment options, and may refer you to a 

specialist, if appropriate. Your provider will also review your potential risk factors for 

substance use disorder and refer you for treatment, if needed. 

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 (starting the day after your 50th birthday). 
100 Section 2: Items & services

Prostate cancer screenings (continued)

How often

Once every 12 months.

Costs

• Digital rectal exams: After you meet the Part B deductible, you pay 20% of the 

Medicare-approved amount for a yearly digital rectal exam and for your doctor’s 

services related to the exam. In a hospital outpatient setting, you also pay a 

separate hospital visit 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.

Prosthetic devices 

Part B covers prosthetic devices needed to replace a body part or function when a 

Medicare-enrolled doctor or other health care provider orders them. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount 

for external prosthetic devices. 

What it is

Examples of prosthetic devices include:

• Breast prostheses (including a surgical bra). See “Breast prostheses” on 

pages 16–17.

• One pair of conventional eyeglasses or contact lenses provided after a cataract 

operation.

• Ostomy bags and certain related supplies. See “Ostomy supplies” on page 85.

• Some surgically implanted prosthetic devices, including cochlear implants.

• Urological supplies.

Things to know

For Medicare to pay for your prosthetic device, you must go to a Medicare-enrolled 

supplier. This is true no matter who submits the claim (you or your provider). Either 

Part A or Part B covers a surgically implanted prosthetic device, depending on 

whether the surgery takes place in an inpatient or outpatient setting.
Section 2: Items & services 101

Prosthetic devices (continued)

More information

• See “Inpatient hospital care” on pages 61–63 for Part A-covered surgeries to 

implant prosthetic devices in a hospital inpatient setting.

• See “Outpatient hospital services” on pages 85–86 for Part B-covered surgeries 

to implant prosthetic devices in a hospital outpatient setting.

• Visit Medicare.gov/coverage/prosthetic-devices.

Pulmonary rehabilitation programs

Part B covers a comprehensive pulmonary rehabilitation program if you have 

moderate to very severe chronic obstructive pulmonary disease (COPD). Starting 

January 1, 2022, Medicare will also cover pulmonary rehabilitation if you’ve had 

confirmed or suspected COVID-19 and experience persistent symptoms that include 

respiratory dysfunction for at least 4 weeks.

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

Pulmonary rehabilitation programs help you breathe better, get stronger, and be able 

to live more independently.

Things to know

You can get these services in a doctor’s office or a hospital outpatient setting that 

offers pulmonary rehabilitation programs.

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).
102 Section 2: Items & services

Radiation therapy (continued)

• If you’re an outpatient, you pay a set copayment and the Part B deductible applies.

• In a freestanding clinic, you pay 20% of the Medicare-approved amount for the 

therapy after you meet the Part B deductible.

More information

Visit Medicare.gov/coverage/radiation-therapy.

Rectal exams 

See “Prostate cancer screenings” on pages 99–100.

Religious nonmedical health care institution items & services 

Religious nonmedical health care institutions provide care and services to people who 

don’t accept conventional medical care because of their religious beliefs. Medicare may 

cover items and services in religious nonmedical health care institutions only if you 

qualify for inpatient hospital or skilled nursing facility (SNF) care. Medicare will only 

cover the inpatient non-religious, nonmedical items and services, like room and board, 

unmedicated wound dressings, or use of a simple walker (items or services that don’t 

require a doctor’s order or prescription). 

Medicare doesn’t cover the religious portion of this type of care. However, Part A covers 

inpatient non-religious, nonmedical care when all of these conditions are met:

• The religious nonmedical health care institution is currently certified to participate 

in Medicare.

• The religious nonmedical health care institution Utilization Review Committee 

agrees that you would require hospital or SNF care if you weren’t in the institution.

• You have a written election on file with Medicare that your need for religious 

nonmedical health 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 religious nonmedical health care services. You’re always eligible to get 

medically necessary Part A services.

Costs

You pay this for each benefit period in 2022:

• $1,556 deductible.

• Days 1–60: $0 coinsurance.

• Days 61–90: $389 coinsurance per day. 
Section 2: Items & services 103

Religious nonmedical health care institution items & services 

(continued)

Costs

• Days 91 and beyond: $778 coinsurance per each “lifetime reserve day” after 

day 90 for each benefit period (up to a maximum of 60 reserve days over your 

lifetime).

• Each day after the lifetime reserve days: All costs. 

Things to know

Religious beliefs prohibit conventional and unconventional medical care in religious 

nonmedical health care institutions.

More information

Visit Medicare.gov/coverage/religious-non-medical-health-care-institution-itemsservices.

Respite care 

See “Hospice care” on pages 58–60.

Rural health clinic services 

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

rural health clinics. 

Costs

After you meet the Part B deductible, you generally pay 20% of the charges. You pay 

nothing for most preventive services. 

What it is

Rural health clinics are located in non-urbanized areas. These clinics provide 

outpatient primary care and preventive health services to people located in medically 

underserved or shortage areas. 

More information

Visit Medicare.gov/coverage/rural-health-clinic-services.

Scooters 

See “Wheelchairs & scooters” on page 116.
104 Section 2: Items & services

Second surgical opinions 

In some cases, Part B covers a second surgical opinion for medically necessary 

surgery that isn’t an emergency. Medicare will also help pay for a third surgical 

opinion if the first and second opinions are different. 

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

The second doctor may ask you to get additional tests as a result of the visit. Medicare 

will help pay for these tests, just as it helps pay for other services that are medically 

necessary. If the second opinion is different from the first opinion, you pay 20% of the 

Medicare-approved 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. 

Sexually transmitted infection 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 face-to-face, high-intensity behavioral counseling sessions 

if you’re a sexually active adult at increased risk for STIs. Each session can be 20-30 

minutes long. 

How often

Medicare covers STI screenings once every 12 months, or at certain times during 

pregnancy. Medicare covers up to 2 behavioral counseling sessions each year.

Costs

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

accepts assignment.
Section 2: Items & services 105

Sexually transmitted infection screenings & counseling (continued)

Things to know

Your primary care provider must order the screening or refer you for behavioral 

counseling. Medicare will only cover counseling sessions with a primary care doctor 

in a primary care setting (like a doctor’s office). Medicare won’t cover counseling in an 

inpatient setting (like a skilled nursing facility). 

More information

Visit Medicare.gov/coverage/sexually-transmitted-infections-screenings-counseling.

Shingles shots

Neither Part A nor Part B cover the shingles shot. Usually, Part D covers all commercially 

available vaccines needed to prevent illness, including the shingles shot. 

More information

• Contact your Medicare drug plan.

• Visit Medicare.gov/coverage/shingles-shot.

Shots (or vaccines)

Part B covers:

• Flu shots: See page 50.

• Hepatitis B shots: See pages 54–55.

• Pneumococcal shots: See page 92.

• Coronavirus disease 2019 (COVID-19) vaccine: See page 30.

• Some other vaccines when they’re related directly to the treatment of an injury or 

illness. These aren’t considered preventive services.

Part D generally covers all other recommended adult immunizations (like shingles, 

Tetanus, diphtheria, and pertussis vaccines) to prevent illness. Talk to your provider 

about which ones are right for you.
106 Section 2: Items & services

Skilled nursing facility (SNF) care 

Part A covers skilled nursing facility care 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. You must get the care 

from, or under the supervision of, skilled nursing or therapy staff.

• You get these skilled services in a Medicare-certified SNF.

• 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. 

Costs

In 2022, you pay these amounts 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 coinsurance. 

• Days 21–100: Up to $194.50 coinsurance each day.

• Days 101 and beyond: 100% of all costs.

There’s a 100-day limit of Part A SNF coverage in each benefit period.
Section 2: Items & services 107

Skilled nursing facility (SNF) care (continued) 

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 in a 

skilled nursing facility include, but aren’t limited to:

• A 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 81 and 91.

• Speech-language pathology services, if they’re needed to meet your health goal. 

See page 108.

• Medical social services.

• Medications.

• Medical supplies and equipment used in the facility.

• Ambulance transportation (when other transportation endangers your 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.

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

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

Things to know

Medicare only covers Type I tests if they’re done in a sleep lab facility. Your doctor 

must order the sleep test. 

More information

Visit Medicare.gov/coverage/sleep-studies.
108 Section 2: Items & services

Speech-language pathology services 

Part B helps pay for medically necessary outpatient speech-language pathology 

services if your doctor or other health care provider certifies you need it.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

What it is

These services provide evaluation and treatment to regain and strengthen speech and 

language skills. This includes cognitive and swallowing skills, or therapy to improve or 

maintain current function or slow decline.

Things to know

There’s no limit on how much Medicare pays for your medically necessary, outpatient 

speech-language pathology 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 that you typically use at home, 

like bandages and gauze.

Costs

You pay 100% for most common medical supplies you use at home. 

More information

Visit Medicare.gov/coverage/supplies.

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 you won’t know what services you need until you meet with your provider. 

If you need surgery or a procedure, you may be able to estimate how much you’ll 

have to pay. For help estimating costs on surgical procedures in certain settings, visit 

Medicare.gov/procedure-price-lookup.

More information

Visit Medicare.gov/coverage/surgery.
Section 2: Items & services 109

Surgical dressing services 

Part B covers medically necessary treatment of a surgical or surgically treated wound.

Costs

You pay 20% of the Medicare-approved amount for your doctor or other health care 

provider’s services, and you usually pay nothing additional for the supplies. You also pay a 

separate 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 

when the facility has entered into a “swing-bed agreement” with the Department of 

Health and Human Services.

Costs

When swing beds provide SNF-level care, the same coverage and cost-sharing rules 

apply as though the services were provided in an SNF.

What it is

A 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.

Tdap shots 

Part A and Part B don’t cover the Tdap shot. Usually, Part D covers all commercially 

available vaccines needed to prevent illness, including the Tdap shot.

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.

More information

• Contact your Medicare drug plan.

• Visit Medicare.gov/coverage/tdap-shots.
110 Section 2: Items & services

Telehealth 

Part B covers certain telehealth services.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount 

for your doctor or other health care provider’s services. For many telehealth services, 

you’ll pay the same amount that you would if you got the services in person.

What it is

Telehealth includes certain medical or health services that you get from your doctor 

or other health care provider using audio and video communications technology, like 

your phone or a computer (or audio-only telehealth services in some cases). Some 

examples of Medicare-covered telehealth services include: 

• Therapy and online counseling 

• Prescription management 

• Urgent care issues, like colds, coughs and stomach aches

• Post-surgical follow-up

• Treatment of recurring conditions, like migraines or urinary tract infections

• Treatment of skin conditions

• Lab test or X-ray result consultations

Things to know

Medicare Advantage Plans and providers who are part of certain Medicare Accountable 

Care Organizations (ACOs) may offer more telehealth benefits than Original Medicare. 

These benefits will be available in a variety of places, and you can use them to get 

services at home instead of going to a health care facility. Check with your plan to see 

what additional telehealth benefits it may offer. If your provider participates in an ACO, 

check with them to see what telehealth benefits may be available. 

More information

Visit Medicare.gov/coverage/telehealth.
Section 2: Items & services 111

Therapeutic shoes or inserts 

Part B covers the furnishing and fitting of either custom 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, you can get either one pair of custom shoes or inserts, or one pair 

of extra depth shoes. You can also get either 2 or 3 additional pairs of inserts each 

calendar year, depending on your shoe type.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

Things to know

The doctor who treats your diabetes must certify your need for therapeutic shoes 

or inserts. A podiatrist (foot doctor) or other qualified doctor must prescribe the 

shoes or inserts, and you must get the shoes or inserts from a podiatrist, orthotist, 

prosthetist, pedorthist, or other qualified individual.

More information

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

supplies” on pages 35–36.

• Visit Medicare.gov/coverage/therapeutic-shoes-or-inserts.
112 Section 2: Items & services

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 42–44.

• Visit Medicare.gov/coverage/traction-equipment.

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’ll work with you, your family, caregivers, and other 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

• Help you with referrals or arrangements for follow-up care or community resources

• Help you with scheduling

• Manage your medications

More information

Visit Medicare.gov/coverage/transitional-care-management-services.
Section 2: Items & services 113

Travel outside the U.S. 

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 U.S. 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.

Costs

In most cases, you pay 100% of the costs. In the situations described above, you pay 

the coinsurance or copayments and deductibles you would pay if you got the same 

services or supplies inside the U.S. 

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.
114 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

After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount for your doctor or other health care provider’s services. In a hospital 

outpatient setting, you also pay a copayment.

More information

Visit Medicare.gov/coverage/urgently-needed-care.

Vaccinations 

See “Shots (or vaccines)” on page 105.

Vaginal cancer screenings 

See “Cervical & vaginal cancer screenings” on pages 19–20.

Virtual check-ins 

Part B covers virtual check-ins (also called “brief communication technology-based 

services”) with your doctors and certain other providers.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved 

amount for your doctor or other provider’s services. 

What it is

Virtual check-ins allow you to talk to your doctor or certain other providers (like 

nurse practitioners or physician assistants) using audio and video communication 

technology, like your phone or a computer, without going to the doctor’s office. Your 

doctor can also conduct remote assessments using photo or video images you send 

for review to see whether you need to go to the doctor’s office.

Your doctor or other provider can respond to you using a phone, virtual delivery, 

secure text messages, email, or a patient portal.
Section 2: Items & services 115

Virtual check-ins (continued) 

Things to know

You can have a virtual check-in if you meet these conditions:

• You’ve talked to your doctor or other provider about starting these types of 

services.

• The virtual check-in doesn’t relate to a medical visit you’ve had within the past 

7 days, and doesn’t lead to a medical visit within the next 24 hours (or the 

soonest appointment available).

• You verbally consent to the virtual check-in, and your doctor documents your 

consent in your medical record. Your doctor may get one consent for a year’s 

worth of these services.

More information

Visit Medicare.gov/coverage/virtual-check-ins.

Walkers 

Medicare Part B covers walkers, including rollators, as durable medical equipment 

(DME). The walker must be medically necessary, and your doctor or other treating 

provider must prescribe it for use in your home.

More information

• See “Durable medical equipment (DME)” on pages 42–44.

• Visit Medicare.gov/coverage/walkers.
116 Section 2: Items & services

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. Part B covers 

power wheelchairs only when they’re medically necessary.

More information

• See “Durable medical equipment (DME)” on pages 42–44.

• Visit Medicare.gov/coverage/wheelchairs-scooters.

X-rays 

Part B covers medically necessary diagnostic X-rays when your treating doctor or other 

health care provider orders them.

Costs

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. 

In a hospital outpatient setting, you also pay a separate facility copayment.

More information

• See “Diagnostic non-laboratory tests” on page 37.

• Visit Medicare.gov/coverage/x-rays.
Section 2: Items & services 117

It may be helpful to understand these terms as you read this 

booklet (visit Medicare.gov/glossary for additional terms): 

Assignment:

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.

Coinsurance:

An amount you may be required to pay as your share of the cost for services after you 

pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Copayment:

An amount you may be required to pay as your share of the cost for a medical service 

or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. A 

copayment is usually a set amount, rather than a percentage. For example, you might 

pay $10 or $20 for a doctor’s visit or prescription drug.

Deductible:

The amount you must pay for health care or prescriptions before Original Medicare, 

your Medicare Advantage Plan, your Medicare drug plan, or your other insurance 

begins to pay.

Medicare-approved amount:

In Original Medicare, this is the amount a doctor or supplier that accepts assignment 

can be paid. It may be less than the actual amount a doctor or supplier charges. 

Medicare pays part of this amount and you’re responsible for the difference.
118 Section 2: Items & services

CMS Accessible Communications

The Centers for Medicare & Medicaid Services (CMS) provides free auxiliary 

aids and services, including information in accessible formats like braille, 

large print, data or audio files, relay services and TTY communications. If 

you request information in an accessible format from CMS, you won’t be 

disadvantaged by any additional time necessary to provide it. This means you’ll 

get extra time to take any action if there’s a delay in fulfilling your request.

To request Medicare or Marketplace information in an accessible format you 

can:

1. Call us:

For Medicare: 1-800-MEDICARE (1-800-633-4227)

TTY: 1-877-486-2048

2. Send us a fax: 1-844-530-3676

3. Send us a letter:

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

Your request should include your name, phone number, type of information 

you need (if known), and the mailing address where we should send the 

materials. We may contact you for additional information.

Note: If you’re enrolled in a Medicare Advantage Plan or Medicare drug 

plan, contact your plan to request its information in an accessible format. For 

Medicaid, contact your State or local Medicaid office.
119

Nondiscrimination Notice

The Centers for Medicare & Medicaid Services (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.

You can contact CMS in any of the ways included in this notice if you have 

any concerns about getting information in a format that you can use. 

You may also file a complaint if you think you’ve been subjected to 

discrimination in a CMS program or activity, including experiencing 

issues with getting information in an accessible format from any Medicare 

Advantage Plan, Medicare drug plan, State or local Medicaid office, or 

Marketplace Qualified Health Plans. There are three ways to file a complaint 

with the U.S. Department of Health and Human Services, Office for Civil 

Rights:

1. Online:

hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html.

2. By phone:

Call 1-800-368-1019. TTY users 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

This product was produced at U.S. taxpayer expense.
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 January 2022

Your Medicare Benefits

■ Medicare.gov 

■ 1-800-MEDICARE (1-800-633-4227) 

■ TTY: 1-877-486-2048 

This booklet is available in Spanish. To get a free copy, visit 

Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). 

TTY users can call 1-877-486-2048.

Esta publicación está disponible en Español. Para obtener una 

copia gratis, visite Medicare.gov o llame al 1-800MEDICARE 

(18006334227). Los usuarios de TTY pueden llamar al 

18774862048.