What Does Medicare Cover?

When you first get Medicare coverage, you’ll probably have questions about what is and isn’t covered. Does Medicare cover doctor visits? What about lab tests, naturopathic doctors, or telehealth services? These are all important questions that Oak Street Health can help answer so that you can make the most of your Medicare benefits.

Understanding the Different Types of Medicare

To understand what’s covered under your Medicare plan, it’s first helpful to understand the different types of Medicare. Original Medicare includes Part A and Part B.

  • Part A: covers inpatient hospital services
  • Part B: covers medically necessary outpatient services, such as doctor visits and preventive care

Original Medicare does not include Part D, which covers prescription drugs. You can purchase this coverage separately.

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What Other Medicare Plans Cover

There is also Medicare Advantage, which is known as Part C. This is a type of all-in-one insurance offered by private companies that covers Parts A and B, and usually D. These plans may offer additional benefits that Original Medicare does not have, such as vision, dental, and hearing services.

Finally, there’s Medicare supplement insurance known as Medigap. This is for people who have Original Medicare. It pays for some of the costs not covered by Medicare, such as:

  • Copayments
  • Coinsurance
  • Deductibles

Does Medicare Cover Doctor Visits?

Medicare covers doctor visits that are considered medically necessary. Medicare Part B will cover 80% of the approved cost after you meet your deductible for the year. (In 2021, that is $203.)

If you have any questions about whether your visit falls into that category, talk to your Oak Street Health team. You can also consult the “Medicare & You” handbook that is updated once a year. It’s mailed to Medicare beneficiaries each fall. You can also call 1-800-MEDICARE.

Does Medicare Cover Annual Checkups?

As a Medicare beneficiary, you’re entitled to a “Welcome Visit” at Oak Street Health as a review of your health history. When you get this at Oak Street Health, you’ll also receive information about preventive services, such as screenings and vaccines.

After that, Medicare offers a yearly wellness visit. At this visit, you’ll fill out a questionnaire called a Health Risk Assessment. Based on your answers, your Oak Street Health provider will create a personalized plan to help you stay healthy. Neither of these types of visits will cost you anything.

However, Medicare Part B does not cover routine physicals. Some Medicare Advantage plans may offer annual physicals as a benefit.

In general, you don’t have to pay for laboratory services with Medicare. Talk with your Oak Street Health provider about which lab tests are right for you—they are a great tool in diagnosing conditions, evaluating how well treatments are working, and monitoring diseases.

Does Medicare Cover Diagnostic Laboratory Services?

Medicare does cover many laboratory services, including:

  • Certain blood tests
  • Urine tests
  • Certain tests on tissue specimens
  • Some screening tests (for example, Medicare covers up to two glucose lab test screenings per year if your doctor determines you’re at risk for developing diabetes)

Does Medicare Cover Naturopathic Doctors?

Naturopathic medicine is focused on natural therapeutic traditions and self-healing. In most cases, Medicare will not cover visits for naturopathic services, although there are a few exceptions.

Medicare will cover medical nutrition therapy for patients who have diabetes or kidney disease, and will cover chiropractic services in one case: when manipulation of the spine is medically necessary to correct a bone that has moved out of place.

Does Medicare Cover Acupuncture?

Acupuncture also falls under the umbrella of naturopathic medicine. Medicare Part B will cover up to 12 acupuncture sessions within 90 days for chronic low back pain. If your pain improves, an additional eight sessions can be covered. Chronic low back pain is the only condition for which Medicare will cover acupuncture. The pain must last for at least 12 weeks and have no known cause. The maximum number of covered acupuncture sessions in a year is 20.

Does Medicare Advantage Cover Naturopathic Medicine?

Many Medicare Advantage plans do offer some coverage for naturopathic medicine. About 20% of Medicare Advantage plans cover acupuncture appointments for conditions beyond just chronic low back pain. Many also have benefits such as fitness memberships, nutrition consultations, and delivery of healthy meals.

Does Medicare Cover Visits with Osteopathic Doctors?

Osteopathic medicine is a medical approach that focuses on how all the systems of the body work together to stay healthy. Medicare Part B does provide coverage for visits with a doctor of osteopathic medicine (these doctors have a D.O. after their name instead of an M.D.), provided that the services and treatments meet Medicare’s standards for being medically necessary.

Does Medicare Cover Telehealth Services?

Yes, Medicare covers many virtual appointments. In spring 2020, Medicare expanded its coverage of telehealth services in response to the COVID-19 public health emergency. Some of the many ways you can use telehealth appointments include:

  • Check-ins on chronic conditions
  • Counseling sessions
  • Health risk assessments
  • Physical and occupational therapy

What Doesn’t Medicare Cover?

There are some common healthcare services for seniors that Medicare does not cover. These include:

  • Most dental care and dentures
  • Eye exams (for eyeglasses)
  • Massage therapy
  • Routine physical exams
  • Hearing aids and exams for fitting them
  • Long-term care