Yes, Medicare covers insulin, and recent legislation has significantly reduced the cost for Medicare beneficiaries. Under the Inflation Reduction Act, insulin covered by a Medicare Part D plan is now capped at $35 per month per insulin product.
The $35 Insulin Cap
Starting in 2023, Medicare Part D plans cannot charge more than $35 per month’s supply of covered insulin. This applies to all insulins on a plan’s formulary, regardless of which coverage phase you are in. You do not need to meet your deductible before the cap applies.
Insulin Coverage Through Part B
Medicare Part B (not Part D) covers insulin used with an insulin pump. If you use an insulin pump, your insulin is classified as durable medical equipment and covered under Part B at 80% (you pay 20% after the Part B deductible).
Types of Insulin Covered
Insulin type
Typical coverage
Rapid-acting (Humalog, NovoLog, Fiasp)
Part D — $35/month cap
Long-acting (Lantus, Basaglar, Toujeo)
Part D — $35/month cap
Intermediate-acting (NPH)
Part D — $35/month cap
Insulin for use in pump
Part B — 80% coverage (DME)
Insulin Supplies
Insulin syringes, pen needles, alcohol swabs, and insulin pumps are covered under Part B as durable medical equipment or medical supplies. Your Part D plan may also cover lancets and test strips — check your plan’s formulary.
Medicare Part D covers Ozempic (semaglutide) when prescribed for type 2 diabetes management. However, Medicare does NOT cover Ozempic or other GLP-1 drugs when prescribed solely for weight loss — this remains a significant coverage gap as of 2024.
Ozempic for Diabetes: Covered
Ozempic is FDA-approved for type 2 diabetes and is covered under Medicare Part D plans that include it on their formulary. Your cost depends on your plan’s tier structure—Ozempic is typically a Tier 3 or Tier 4 medication with higher cost-sharing.
Wegovy for Weight Loss: Not Covered (Yet)
Wegovy is the same drug (semaglutide) at a higher dose, approved specifically for chronic weight management. Original Medicare and most Part D plans do not cover Wegovy because Congress has not yet authorized Medicare coverage of weight loss drugs. Some Medicare Advantage plans have begun adding obesity drug coverage, but this is still uncommon.
Mounjaro, Zepbound, and Other GLP-1 Drugs
Mounjaro (tirzepatide) — covered by Part D when prescribed for type 2 diabetes
Zepbound (tirzepatide)—same drug as Mounjaro but at obesity-approved dosage; not covered for weight loss only
Rybelsus (oral semaglutide) — covered for type 2 diabetes under Part D
Potential Future Coverage
There is active legislative discussion about adding obesity drug coverage to Medicare. The Treat and Reduce Obesity Act (TROA) has been introduced in Congress multiple times. As GLP-1 drugs become more widely recognized as medical treatments for obesity, coverage is expected to expand—follow Medicare.gov for updates.
Reducing Your Ozempic Costs
Manufacturer savings programs (NovoCare) may reduce out-of-pocket costs
Compare Part D plans annually at Medicare.gov—formularies and costs differ
Extra Help (LIS) program reduces drug costs for low-income beneficiaries
Original Medicare generally does NOT cover eyeglasses or contact lenses. There is one important exception: Medicare Part B covers one pair of standard eyeglasses or one set of contact lenses following cataract surgery with an intraocular lens implant.
The Post-Cataract Surgery Exception
After cataract surgery where an intraocular lens (IOL) is implanted, Medicare Part B covers:
One pair of standard frames with basic lenses, OR
One set of contact lenses
If you choose premium frames or upgraded lenses beyond the standard Medicare benefit, you pay the difference. Ask your eye doctor what Medicare will cover before selecting your frames.
Getting Eyeglass Coverage Through Medicare Advantage
Many Medicare Advantage plans include a vision benefit:
Routine eye exam (usually once per year)
Annual allowance toward frames and lenses ($100–$300 on most plans)
Some plans offer enhanced vision benefits with higher allowances
If eyeglass coverage is important to you, prioritize it when comparing Medicare Advantage plans.
Affordable Eyeglasses for Seniors Without Coverage
EyeBuyDirect, Zenni, and Warby Parker offer frames starting at $6–$30 online
Costco Optical — significant savings on in-store exams and glasses
Lions Club Recycle for Sight program — free eyeglasses for low-income seniors
VSP Vision Care — standalone vision insurance plans available to seniors
Yes, Medicare Part B covers glaucoma testing once every 12 months for people at high risk for glaucoma. You pay 20% of the Medicare-approved amount after your Part B deductible for the exam and dilation.
Who Qualifies for the Free Annual Glaucoma Test?
People with diabetes
People with a family history of glaucoma
African Americans age 50 and older
Hispanic Americans age 65 and older
What the Glaucoma Test Includes
Visual field testing (perimetry)
Dilated eye exam
Measurement of eye pressure (tonometry)
Examination of the optic nerve
Who Can Perform the Glaucoma Exam?
The glaucoma test must be performed by or under the direct supervision of an ophthalmologist (MD eye specialist) or optometrist who is licensed by the state to perform these services.
Treatment for Glaucoma
If glaucoma is diagnosed, Medicare covers medical treatment including:
Yes — but only one specific service. Medicare Part B covers chiropractic manipulation of the spine when medically necessary to treat a subluxation. That is the entirety of what Medicare covers in a chiropractor’s office. X-rays, diagnostic testing, massage, physical therapy, and any other services are explicitly excluded — even when performed in the same visit.
Millions of Medicare beneficiaries see chiropractors regularly for back and neck pain relief. Understanding precisely what Medicare will and won’t pay for — before you hand over your Medicare card — prevents frustrating surprise bills. The coverage is narrower than most patients expect.
Article Contents
What Is Subluxation — and Why Does It Matter for Coverage?
Subluxation is the medical term for a partial dislocation or misalignment of one or more vertebrae in the spine that causes neurological interference. Medicare’s entire chiropractic coverage is built around this single concept. To qualify for covered chiropractic care, your chiropractor must:
Diagnose a subluxation of the spine through physical examination
Document the location of the subluxation (cervical, thoracic, or lumbar spine)
Perform manual manipulation to correct the subluxation
Document the patient’s response to treatment
Chiropractic care for general wellness, muscle soreness, joint pain in the extremities (shoulders, knees, hips), or conditions that don’t involve spinal subluxation is not covered by Medicare — regardless of how beneficial that care might be.
Exactly What Medicare Covers vs. Does Not Cover at a Chiropractor
Physical therapy performed in a chiropractic office
Not covered
Electrical stimulation (TENS, ultrasound)
Not covered when billed by a chiropractor
Nutritional supplements or orthotics
Not covered
Maintenance chiropractic (to maintain current condition)
Not covered — only active treatment for subluxation
Chiropractic adjustment of extremities (knee, shoulder, etc.)
Not covered
The maintenance exclusion catches many patients off guard. Medicare covers chiropractic care only for active treatment — when the goal is to improve your condition. Once your subluxation has been treated and additional visits are only maintaining your current level of function (rather than producing further improvement), Medicare considers the care “maintenance” and stops covering it. If your chiropractor continues billing Medicare for maintenance visits, you may receive a bill retroactively.
How to Protect Yourself: The Advance Beneficiary Notice (ABN)
If your chiropractor believes that upcoming care may not be covered by Medicare—either because it is maintenance care or because coverage is otherwise uncertain—they are required to give you a written Advance Beneficiary Notice of Noncoverage (ABN) before providing the service.
The ABN explains why Medicare may not pay and gives you options:
Option 1: Receive the service knowing you may have to pay and want Medicare to decide. The chiropractor will submit the claim, and Medicare will make the coverage determination.
Option 2: Receive the service, accept that you will pay personally, and ask the chiropractor not to submit a claim to Medicare.
Option 3: Decline the service.
If a chiropractor provides a service they know won’t be covered without giving you an ABN first, they cannot legally bill you for it. Always ask your chiropractor at the start of treatment whether all recommended services will be billed to Medicare or whether some are expected to be non-covered.
Is There a Limit on How Many Chiropractic Visits Medicare Covers?
There is no fixed annual limit on the number of chiropractic visits Medicare will cover. Medicare will continue covering spinal manipulation visits as long as the following are true:
Your chiropractor documents an active subluxation requiring treatment
The treatment is producing measurable clinical improvement
The care has not transitioned to maintenance-only status
In practice, most Medicare-covered chiropractic courses of treatment run 6–12 visits before the condition stabilizes. At that point, additional visits are likely to be characterized as maintenance and become your financial responsibility.
What You Pay for Chiropractic Under Medicare in 2026
When a chiropractic adjustment is covered, standard Part B cost-sharing applies:
You meet your $283 annual Part B deductible (if not yet met for the year)
Medicare pays 80% of the Medicare-approved amount for the spinal manipulation
You pay 20% coinsurance
Medicare’s approved amount for chiropractic spinal manipulation is typically $35–$70 per visit depending on the region and the complexity of the manipulation (one region vs. multiple spinal regions). Your 20% coinsurance would be approximately $7–$14 per covered visit.
Remember: any non-covered services (X-rays, massage, ultrasound, supplements) are billed entirely out of pocket at the chiropractor’s private rates, which have nothing to do with the Medicare-approved amount.
Before your first visit: Ask the chiropractor’s office to confirm (1) they accept Medicare assignment, (2) exactly which services they will bill to Medicare, and (3) what their private-pay rates are for any services Medicare doesn’t cover. Getting this in writing before treatment begins prevents billing disputes later.
Does Medicare Advantage Cover More Chiropractic Services?
Sometimes, but not always. Medicare Advantage plans must cover the same chiropractic benefit as Original Medicare — spinal manipulation for subluxation. Some Advantage plans add expanded chiropractic benefits as a supplemental offering, which may include a set number of visits for general musculoskeletal care or coverage for some ancillary services. Check your plan’s Summary of Benefits for your specific chiropractic coverage.
Frequently Asked Questions
Does Medicare cover chiropractic care for neck pain?
Yes—if the neck pain is caused by a diagnosed cervical subluxation and the treatment is active chiropractic manipulation. The cervical spine is one of the three spinal regions (cervical, thoracic, lumbar) covered under Medicare’s subluxation policy. General neck tension, myofascial pain without subluxation, or maintenance visits for neck pain are not covered.
Can I see a chiropractor and a physical therapist for the same condition?
Yes. Medicare covers both chiropractic manipulation (Part B) and physical therapy (Part B) as separate services. They can be ordered for the same underlying condition. However, they cannot be billed on the same date of service for the same procedure without specific documentation showing they addressed distinct issues.
Does Medicare cover chiropractic care for scoliosis?
If a patient with scoliosis also has subluxations that require active manipulation, Medicare may cover those specific chiropractic visits. Scoliosis alone is not a qualifying condition; the subluxation diagnosis and documentation are still required.
What if my chiropractor doesn’t accept Medicare?
Some chiropractors opt out of Medicare entirely and charge their own rates. If you see a non-Medicare provider, Medicare will not reimburse any portion of the cost. If your chiropractor accepts Medicare but does not accept assignment, they can charge up to 115% of the Medicare-approved rate — meaning you pay the 20% coinsurance plus up to 15% above the approved amount.
This article is for informational purposes only. Medicare chiropractic coverage rules are governed by CMS national and local coverage determinations. Your Medicare Administrative Contractor (MAC) may have additional local policies. Verify at Medicare.gov or call 1-800-MEDICARE.
Original Medicare (Parts A and B) does NOT cover gym memberships. However, many Medicare Advantage plans include fitness benefits like SilverSneakers, Silver&Fit, or Renew Active—offering free or discounted gym access at thousands of locations nationwide.
SilverSneakers: The Most Popular Medicare Fitness Benefit
SilverSneakers is a fitness program specifically designed for adults 65 and older, included at no extra cost with many Medicare Advantage and Medicare Supplement plans. Members get:
Free access to 15,000+ fitness locations nationwide
On-demand fitness classes online
Instructor-led classes designed for older adults
Social community and wellness resources
How to Check If Your Plan Includes SilverSneakers
Visit silversneakers.com and click ‘Check Eligibility’
Enter your insurance information to see if your plan qualifies
Call the member services number on your insurance card
Alternative Fitness Benefits
Program
Typically included with
SilverSneakers
Humana, Tufts, and many regional Medicare Advantage plans
Renew Active
UnitedHealthcare Medicare Advantage plans
Silver & Fit
Aetna, Cigna, and other Medicare Advantage plans
One Pass Select
Various Medicare Advantage plans
Why Fitness Benefits Matter for Seniors
Regular physical activity is one of the most evidence-based interventions for preventing falls, managing chronic disease, and maintaining cognitive function — all major priorities for Medicare beneficiaries. If your plan includes a fitness benefit, using it is one of the highest-value no-cost health actions available to you.
Finding a Plan with Fitness Benefits
Use Medicare’s Plan Finder at Medicare.gov during open enrollment to filter plans by additional benefits. Select ‘Fitness’ or ‘SilverSneakers’ as a filter to identify plans that include gym access in your area.
Yes, Medicare covers cataract surgery. If you have Medicare Part B, standard cataract surgery is covered as a medically necessary outpatient procedure. You will pay 20% of the Medicare-approved amount after your Part B deductible is met.
What Medicare Part B Covers
The surgical procedure to remove the cataract
One pair of standard eyeglasses OR one set of contact lenses after surgery (this is the only time Medicare covers glasses)
Pre-operative and post-operative visits related to the surgery
Anesthesia administered during the procedure
What Medicare Does NOT Cover for Cataract Surgery
Premium intraocular lenses (IOLs) that correct astigmatism or presbyopia — you pay the upgrade cost out of pocket
Laser cataract surgery if you choose it solely for lifestyle preference (the standard technique is covered; any laser premium is your responsibility)
Routine eye exams before or after surgery that are unrelated to the cataract
Medicare Advantage and Cataract Surgery
Medicare Advantage (Part C) plans must cover everything Original Medicare covers, so cataract surgery is always included. Some plans may offer additional lens upgrade allowances—check your plan’s Summary of Benefits.
How Much Will You Pay?
Part B deductible
$240 in 2024 (you pay this first)
Coinsurance
20% of Medicare-approved amount after deductible
With Medigap
A Medigap (supplement) plan often covers your 20% coinsurance
Frequently Asked Questions
Does Medicare cover both eyes?
Yes. Medicare covers cataract surgery on each eye, typically as separate procedures scheduled weeks apart.
Is there a waiting period?
No waiting period applies as long as your doctor certifies the procedure is medically necessary.
What if I want premium lenses?
Medicare will pay its standard approved amount for a basic monofocal lens. If you upgrade to a premium toric or multifocal IOL, you pay the difference. Ask your surgeon for a cost estimate before scheduling.
Yes, Medicare Part B covers CPAP machines and related supplies when you have been diagnosed with obstructive sleep apnea. Medicare classifies CPAP machines as durable medical equipment (DME), and you pay 20% of the Medicare-approved amount after your Part B deductible.
Requirements for Medicare to Cover Your CPAP
You must have a written order from a Medicare-enrolled doctor
A sleep study must document your diagnosis of obstructive sleep apnea
The supplier must be a Medicare-enrolled DME supplier
You must demonstrate that the CPAP therapy is helping — Medicare requires a follow-up visit within 90 days of starting CPAP therapy
The 3-Month Trial Period
Medicare initially rents the CPAP machine for a 3-month trial. If your doctor documents that CPAP therapy is helping you, Medicare continues to rent the equipment. After 13 months of continuous rental, Medicare ownership transfers to you.
What Supplies Medicare Covers
CPAP machine (rented, then owned after 13 months)
Replacement masks — typically every 3 months
Tubing — typically every 3 months
Filters — typically every month (disposable) or every 6 months (reusable)
Humidifier chamber — typically every 6 months
Chinstrap (if medically necessary)
BiPAP and Other Sleep Therapy Devices
Medicare also covers BiPAP machines and APAP (auto-adjusting) devices under the same DME rules. The clinical requirements are similar — documented sleep apnea, physician order, Medicare-enrolled supplier.
How to Ensure Coverage
Use only Medicare-enrolled DME suppliers (you can search at Medicare.gov)
Get a new prescription and updated sleep study if your equipment is more than 5 years old
Keep records of your usage — Medicare may request data downloads from your CPAP to confirm ongoing use
Yes, Medicare covers bariatric surgery — but only under specific conditions. You must have a BMI of 35 or higher, at least one serious obesity-related health condition, and documentation that your doctor has managed your obesity for at least 6 months without success through nonsurgical means.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Sleeve Gastrectomy (gastric sleeve) — covered at facilities with approved bariatric programs
Eligibility Requirements
BMI requirement
35 or higher
Co-morbid condition
Must have type 2 diabetes, hypertension, or another serious obesity-related condition
Prior treatment
At least 6 months of physician-supervised weight loss efforts documented
Facility certification
Surgery must be performed at a Medicare-approved bariatric facility
What Medicare Pays For
The surgical procedure (Part A for inpatient, Part B for outpatient)
Pre-surgical consultations and lab work
Post-surgical follow-up visits
Nutritional counseling related to post-surgery recovery
What Is Not Covered
Weight loss programs not directly tied to surgical preparation
Weight loss medications
Surgery for cosmetic purposes or BMI under 35 without comorbidities
The Pre-Authorization Process
Medicare requires prior authorization for bariatric surgery at most facilities. Your bariatric surgeon’s office typically handles this, but you should confirm the facility is Medicare-certified and that all documentation is submitted before your scheduled date.
Original Medicare has very limited eye exam coverage. Medicare Part B does NOT cover routine eye exams for glasses or contact lenses. However, Medicare does cover eye exams when related to a diagnosed eye disease or medical condition.
Eye Exams Medicare DOES Cover
Glaucoma screenings — annually for high-risk beneficiaries (diabetes, family history, Hispanic/Black Americans over 65)
Diabetic retinopathy exams — annually for people with diabetes
Eye exams related to macular degeneration treatment
Medical eye exams for cataracts, infections, or injuries
Eye Exams Medicare Does NOT Cover
Routine vision exams for glasses or contact lens prescriptions
Prescription glasses or contact lenses (with one exception: post-cataract surgery)
Refractive error correction
Medicare Advantage Vision Benefits
Many Medicare Advantage plans include routine vision benefits not available under Original Medicare:
Annual routine eye exam
Allowance toward glasses frames and lenses ($100–$300 typically)
Contact lens allowance
Vision benefits vary widely by plan and insurer. Compare plans during Medicare open enrollment (October 15 – December 7) at Medicare.gov.
