Coverage Lookup

Is This Procedure Covered by Medicare?

Search 24 common procedures, services, and items to see what Original Medicare covers, what it costs you, and what's NOT covered (but often included in Medicare Advantage plans).

Knee Replacement (Total)YesPart B

Your cost: Usually outpatient: 20% of the Medicare-approved amount for the surgeon, anesthesia, and facility fees after the Part B deductible ($283). If admitted as an inpatient, you also pay the Part A hospital deductible ($1,736); physician fees still bill under Part B.

Must be medically necessary. After an inpatient stay, skilled nursing rehab costs $217/day for days 21-100. Some Medicare Advantage plans may require pre-approval.

Hip ReplacementYesPart B

Must be medically necessary. After an inpatient stay, skilled nursing rehab costs $217/day for days 21-100. Some Medicare Advantage plans may require pre-approval.

Cataract SurgeryYesPart B

Your cost: 20% of the Medicare-approved amount for the surgeon, anesthesia, and facility fees after the Part B deductible ($283)

One pair of corrective lenses covered after surgery.

Colonoscopy (Screening)Yes - $0Part B

Your cost: $0 for screening. Cost-sharing if polyps removed.

Every 10 years (or 4 years high-risk). No cost if purely screening.

Annual Wellness VisitYes - $0Part B

Your cost: $0 copay

Free once per year after first 12 months on Part B.

Flu ShotYes - $0Part B

Your cost: $0

Covered annually at no cost.

COVID-19 VaccineYes - $0Part B

Your cost: $0

All FDA-authorized vaccines covered at no cost.

Mammogram (Screening)Yes - $0Part B

Your cost: $0 for screening

Annual screening for women 40+.

MRIYesPart B

Your cost: You pay 20% of the Medicare-approved amount

Must be ordered by a doctor. Some Medicare Advantage plans may require pre-approval.

CT ScanYesPart B

Your cost: 20% of the Medicare-approved amount

Must be medically necessary and ordered by physician.

Physical TherapyYesPart B

Your cost: 20% of the Medicare-approved amount per session

Must be ordered by a doctor. No annual cap since 2018 (but threshold review at $2,480).

Cardiac RehabilitationYesPart B

Your cost: 20% of the Medicare-approved amount

After heart attack, bypass, or other qualifying cardiac event. Up to 36 sessions.

Hearing AidsNo

Your cost: $1,000-$6,000+ out of pocket

Original Medicare does NOT cover hearing aids. Many MA plans do include them.

Many Medicare Advantage plans cover this.

Routine Dental (Cleanings)No

Your cost: $200-$400/year out of pocket

Original Medicare does NOT cover routine dental. Many MA plans include dental.

Many Medicare Advantage plans cover this.

Routine Vision (Eye Exams)No

Your cost: $100-$200 out of pocket

Routine eye exams not covered. Glaucoma screening IS covered for high-risk.

Many Medicare Advantage plans cover this.

DenturesNo

Your cost: $1,000-$3,000+ out of pocket

Not covered by Original Medicare. Some MA plans offer dental benefits including dentures.

Many Medicare Advantage plans cover this.

Skilled Nursing FacilityPartialPart A

Your cost: $0 days 1-20, $217/day days 21-100, you pay all costs after day 100

Must follow 3-day inpatient hospital stay. Max 100 days per benefit period.

Home Health CareYesPart A

Your cost: $0 for services, 20% for DME

Must be homebound and need skilled care. Doctor must certify.

Hospice CareYesPart A

Your cost: $0 for most services, small copay for drugs

Doctor must certify terminal illness (6 months or less). Must elect hospice benefit.

Ambulance ServicesYesPart B

Your cost: 20% of the Medicare-approved amount

Covered when medically necessary. Non-emergency transport limited.

Emergency Room VisitYesPart B

Your cost: 20% of the Medicare-approved amount after the Part B deductible ($283)

Covered at any ER in the US. If you are admitted as a hospital inpatient, the hospital stay is billed under Part A and its deductible ($1,736); doctor fees still bill under Part B.

Chiropractic CareLimitedPart B

Your cost: 20% of the Medicare-approved amount

Only manual manipulation of spine to correct subluxation. No maintenance care.

AcupunctureLimitedPart B

Your cost: 20% of the Medicare-approved amount

Only for chronic low back pain. Up to 12 sessions in 90 days (20 max if improving).

Insulin (Part D)Yes - $35/mo capPart D

Your cost: Max $35/month per insulin

Inflation Reduction Act caps insulin at $35/month for all Part D plans.

Questions about what's covered?

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