Health conditions covered by Medicare

that may surprise you

Medicare makes medical goods and services more affordable for eligible Americans. However, there are well-known gaps in the coverage. This can lead many Americans to mistakenly believe their own medical conditions won’t be covered. Don’t worry if you have one of these pre-existing conditions or worry about developing them; all of these health conditions are well-covered under existing Medicare coverage.

1. Alzheimer’s Disease

Approximately 5.3 million of the 5.5 million Americans living with the brain disorder known as Alzheimer’s disease are age 65 or older, according to the Alzheimer’s Association. So, it’s a relief that Medicare covers many of the costs associated with Alzheimer’s disease. These may include:

  • Doctor’s visit, physical exam, and other tests used to diagnose Alzheimer’s disease. Positron Emission Tomography (PET) scans are only covered in certain cases.
  • Doctor’s visits for ongoing treatment.
  • Visits to psychiatrists, clinical psychologists, and social workers for mental health treatment.
  • A walker, wheelchair, oxygen equipment, and other medical supplies your doctor feels you need to live at home.
  • Cholinesterase inhibitors to aid recall and judgment and memantine to improve attention and memory.

However, there are some limits to Medicare’s coverage for Alzheimer’s patients. It will not cover:

  • Long-term care, including nursing home stays over 100 days, assisted living facilities, and adult daycare.
  • Personal care, unless you also need skilled care.

2. Diabetes

The Diabetes Association’s most recent figures show that in 2012, more than 29 million Americans had diabetes. Nearly 12 million of them were age 65 or more. This amounts to more than a quarter of the country’s senior population. Considering its prevalence, you may be surprised to learn that Medicare has quite comprehensive diabetes coverage, including:

  • Up to two diabetes screening tests per year
  • Hemoglobin A1c tests
  • Medical nutrition therapy services
  • Insulin and other diabetes medications
  • External insulin pumps, blood sugar self-testing kits, and other diabetes management devices
  • Podiatry exams and treatment
  • Specialized orthopedic footwear prescribed by a doctor or podiatrist
  • Eye tests for glaucoma
  • Influenza and pneumonia vaccinations

However, there are some limitations to the Medicare coverage. You’ll need to pay out-of-pocket for:

  • Eye refraction exams
  • Physical exams after the annual wellness visit
  • Weight loss initiatives

BONUS: What does Medicare NOT cover?


3. Rheumatoid Arthritis

Rheumatoid arthritis, the most common form of arthritis, is another prevalent condition among older Americans that surprisingly get comprehensive Medicare coverage. Medicare users with rheumatoid arthritis are covered for the following:

  • Testing for rheumatoid arthritis diagnosis.
  • Doctor’s visits for ongoing treatment.
  • Occupational and physical therapies.
  • Rheumatoid arthritis medications, including non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and biologic disease modifying drugs. Note that while biologic disease-modifying drugs are covered to some degree, patients may still incur significant out-of-pocket expenses of $2,700 a year or more, according to Rheumatology News, for their portion of the medication costs.
  • Hospital stays, including surgery, rehabilitation, and skilled nursing care.

There are some exceptions to Medicare’s rheumatoid arthritis coverage, though. Medicare will not usually cover:

  • Alternative therapies or treatments, including the cost of vitamins and other health supplements.

4. Depression

More than 2 million of the 19 million Americans suffering from depression are age 65 or older, according to Mental Health America. Being widowed and suffering a chronic health problem significantly increase the risks. Older Americans with depression typically spend 50% more on medical bills than non-depressed seniors, perhaps because just 28% believe depression is a health problem. Thankfully depression is a health problem that Medicare covers.

  • An annual depression screening
  • Counseling visits with a psychiatrist, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner, or physician assistant who accepts assignment, including family counseling
  • Individual or group psychotherapy sessions
  • Treatment and psychiatric evaluations
  • Medication management
  • Many antidepressants
  • Partial hospitalization

Note that Medicare will not cover:

  • Private duty nursing
  • Personal items required during hospitalization

5. Asthma

The number of Americans with asthma is on the rise. In 2001, 1 in 14 Americans had asthma, according to the American Academy of Allergy, Asthma, and Immunology. But by 2009, that number had grown to 1 in 12. With more Americans impacted by asthma than ever before, it’s comforting that Medicare covers the following:

  • Asthma medications
  • Nebulizers and oxygen equipment
  • Hospital stays
  • Outpatient care
  • Home health care
  • Pneumonia, influenza, and hepatitis B vaccinations
  • Counseling to help asthmatics quit smoking

Note that Medicare does not cover:

  • Private duty nursing
  • Personal items required during hospitalization

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