Medicare Coverage: What’s Included and How to Use It

If you’ve ever stared at your Medicare summary and felt confused, you’re not alone. Medicare isn’t a single blanket that covers everything – it’s split into parts, each with its own rules. Knowing which services fall under Part A, Part B, Part C (Medicare Advantage), and Part D can save you time, money, and a lot of hassle.

Part A handles hospital stays, skilled nursing, and some home health care. That means if you’re admitted for surgery or need rehab after an injury, Part A typically picks up the tab after you meet the deductible. Part B covers doctor visits, outpatient services, and many preventive tests. Think routine check‑ups, blood work, and some medical supplies like glucometers. Part C is offered by private insurers and bundles A, B, and often prescription drugs, but it may have different copays and network rules. Part D solely focuses on prescription medications.

Common Items Medicare Actually Covers

Many people assume Medicare will foot the bill for anything health‑related, but the list is narrower. Here are the big‑ticket items you’re likely to see covered:

• Hospital stays and inpatient care – Part A pays for most of the cost after you hit the deductible.
• Doctor services and outpatient visits – Part B handles routine appointments, specialist visits, and certain procedures.
• Preventive screenings – Mammograms, colonoscopies, flu shots, and yearly wellness visits are covered with little or no cost.
• Durable medical equipment (DME) – Items like wheelchairs, walkers, and oxygen machines can be covered when a doctor orders them.
• Home health care – Skilled nursing or therapy provided at home may be covered under Part A if you meet specific criteria.
• Prescription drugs – If you have Part D or a Medicare Advantage plan that includes drug coverage, many meds are partially paid for.
• Special cases – Some plans, like certain Medicare Advantage policies, will cover sleep‑related equipment such as a Sleep Number bed if it’s deemed medically necessary.

Notice anything missing? Things like routine dental care, most vision services, cosmetic procedures, and over‑the‑counter meds usually aren’t covered unless you add a supplemental plan.

How to Navigate the Coverage Process

Getting Medicare to pay for something isn’t just a click‑and‑forget task. Follow these steps to improve your odds:

1. Check medical necessity – Your doctor must document why a service or item is needed. For equipment, you’ll often need a prescription and a letter of medical necessity.
2. Verify your plan’s rules – Look up whether your specific Part A/B or Advantage plan lists the item. Some services require prior authorization.
3. Submit the claim – Usually, the provider files the claim for you. If you’re buying equipment yourself, you’ll need to fill out a Medicare claim form (CMS-1500) and attach the prescription.
4. Follow up on denials – If Medicare says no, ask for the reason. Often a simple correction or additional documentation can overturn the decision.
5. Consider supplemental coverage – Medigap policies can cover gaps like copays and deductibles, making the overall out‑of‑pocket cost lower.

Pro tip: Keep a folder (digital or paper) with all your Medicare letters, doctor notes, and receipts. When you need to prove eligibility, you’ll have everything at hand and won’t waste time hunting for paperwork.

Medicare can feel like a maze, but breaking it down into parts, knowing what’s covered, and following a clear claim process makes it manageable. Use the steps above, ask questions when you’re unsure, and you’ll get the most value from your coverage without unexpected bills.