What health insurance covers

Preventive care & screenings

Checkups, vaccines, cancer screenings, and birth control, often $0 when criteria are met.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Annual physical	Usually	Conditions	Usually	Usually
Mammogram	Usually	Usually	Usually	Usually
Colonoscopy	Conditions	Conditions	Conditions	Usually
Pap smear	Usually	Usually	Usually	Usually
Vaccines	Usually	Usually	Usually	Usually
Well-child visit	Usually	Usually not	Usually not	Usually
PrEP for HIV	Usually	Usually	Usually	Usually
STI testing	Usually	Usually	Usually	Usually
Prostate cancer screening	Conditions	Usually	Usually	Conditions
Lung cancer screening	Usually	Usually	Usually	Conditions
Bone density scan	Conditions	Usually	Usually	Conditions
Quit smoking programs	Usually	Usually	Usually	Usually

Doctor visits & urgent care

Primary care, specialists, telehealth, urgent care, and the ER.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Primary care visit	Usually	Usually	Usually	Usually
Specialist visit	Conditions	Usually	Conditions	Conditions
Urgent care	Usually	Usually	Usually	Usually
Emergency room	Usually	Usually	Usually	Usually
Telehealth visit	Usually	Usually	Usually	Usually
Second opinion	Usually	Usually	Usually	Conditions
Podiatrist & foot care	Conditions	Conditions	Conditions	Depends
Injections at the doctor’s office	Conditions	Conditions	Conditions	Conditions
Skin check and mole removal	Conditions	Conditions	Conditions	Conditions

Tests & imaging

Lab work, X-rays, MRIs, CT and PET scans, sleep studies, and genetic tests.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
MRI	Conditions	Conditions	Conditions	Conditions
CT scan	Conditions	Conditions	Conditions	Conditions
PET scan	Conditions	Conditions	Conditions	Conditions
X-ray	Usually	Usually	Usually	Usually
Ultrasound	Usually	Usually	Usually	Usually
Thyroid scan	Conditions	Conditions	Conditions	Usually
Blood tests & lab work	Usually	Usually	Usually	Usually
Sleep study	Conditions	Conditions	Conditions	Conditions
Genetic testing	Conditions	Conditions	Conditions	Conditions
Allergy testing & shots	Usually	Conditions	Conditions	Conditions
Biopsy	Conditions	Conditions	Conditions	Usually
Heart tests (EKG, echo, stress test)	Conditions	Conditions	Conditions	Usually
Upper endoscopy (EGD)	Conditions	Conditions	Conditions	Usually

Hospital & surgery

Hospital stays, outpatient surgery, ambulances, cancer treatment, and dialysis.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Hospital stay	Conditions	Conditions	Conditions	Usually
Surgery	Conditions	Conditions	Conditions	Conditions
Ambulance	Conditions	Conditions	Conditions	Usually
Cancer treatment	Conditions	Conditions	Conditions	Usually
Dialysis	Conditions	Usually	Usually	Usually
Infusion therapy	Conditions	Conditions	Conditions	Conditions
Breast reconstruction	Usually	Usually	Usually	Usually

Pregnancy, fertility & family

Prenatal care, childbirth, breast pumps, fertility treatment, and sterilization.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Birth control	Usually	Usually	Usually	Usually
Prenatal care	Usually	Conditions	Conditions	Usually
Childbirth & delivery	Usually	Conditions	Conditions	Usually
Breast pump	Usually	Usually not	Usually not	Conditions
IVF & fertility treatment	Usually not	Usually not	Usually not	Usually not
Vasectomy	Conditions	Usually not	Usually not	Usually
Tubal ligation	Usually	Usually not	Usually not	Usually
Doula care	Usually not	Usually not	Usually not	Conditions
Newborn circumcision	Usually	Usually not	Usually not	Conditions

Mental health & substance use

Therapy, psychiatry, inpatient care, addiction treatment, and autism services.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Depression screening	Usually	Usually	Usually	Usually
Therapy & counseling	Usually	Usually	Usually	Usually
Psychiatrist	Usually	Usually	Usually	Usually
Inpatient mental health care	Conditions	Conditions	Conditions	Conditions
Addiction treatment	Usually	Usually	Usually	Usually
ABA therapy for autism	Conditions	Usually not	Usually not	Usually
TMS, ECT, and Spravato for depression	Conditions	Conditions	Conditions	Conditions
Couples and family counseling	Usually not	Usually not	Usually not	Usually not

Rehab & alternative care

Physical, occupational, and speech therapy, chiropractic care, and acupuncture.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Physical therapy	Conditions	Conditions	Conditions	Conditions
Occupational therapy	Conditions	Conditions	Conditions	Conditions
Speech therapy	Conditions	Conditions	Conditions	Conditions
Cardiac rehab	Usually	Usually	Usually	Conditions
Chiropractor	Conditions	Conditions	Conditions	Depends
Acupuncture	Usually not	Conditions	Conditions	Usually not
Massage therapy	Usually not	Usually not	Usually not	Usually not

Prescription drugs

Generic, brand, specialty, insulin, and GLP-1 medications.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Generic drugs	Usually	Usually	Usually	Usually
Brand-name drugs	Conditions	Conditions	Conditions	Conditions
Specialty drugs	Conditions	Conditions	Conditions	Conditions
Insulin	Usually	Usually	Usually	Usually
Ozempic	Conditions	Conditions	Conditions	Conditions
Wegovy	Usually not	Conditions	Conditions	Usually not
Zepbound	Usually not	Conditions	Conditions	Usually not
Mounjaro	Conditions	Conditions	Conditions	Conditions
ADHD medication	Usually	Usually	Usually	Usually
Botox for migraines and other conditions	Conditions	Conditions	Conditions	Conditions
Erectile dysfunction drugs	Depends	Usually not	Usually not	Usually not
Hormone therapy (menopause or low testosterone)	Usually	Usually	Usually	Usually

Medical equipment & supplies

CPAP, wheelchairs, glucose monitors, insulin pumps, and prosthetics.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
CPAP machine	Conditions	Conditions	Conditions	Conditions
Wheelchair or scooter	Conditions	Conditions	Conditions	Conditions
Walker or cane	Usually	Usually	Usually	Usually
Continuous glucose monitor	Conditions	Conditions	Conditions	Conditions
Insulin pump	Conditions	Conditions	Conditions	Conditions
Prosthetics & orthotics	Conditions	Conditions	Conditions	Conditions
Other medical equipment	Conditions	Conditions	Conditions	Conditions
Bathroom and home safety equipment	Usually not	Usually not	Usually not	Conditions
Diapers and incontinence supplies	Usually not	Usually not	Conditions	Conditions
Home oxygen	Conditions	Conditions	Conditions	Conditions
Diabetic testing supplies	Usually	Usually	Usually	Usually
Hospital bed for home	Conditions	Conditions	Conditions	Conditions

Dental, vision & hearing

Cleanings, braces, eye exams, glasses, LASIK, and hearing aids.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Hearing test	Conditions	Conditions	Conditions	Conditions
Hearing aids	Usually not	Usually not	Usually	Depends
Dental care	Usually not	Usually not	Usually	Depends
Braces & orthodontics	Usually not	Usually not	Usually not	Conditions
Eye exam	Conditions	Conditions	Usually	Depends
Glasses & contacts	Usually not	Usually not	Usually	Depends
Cataract surgery	Conditions	Conditions	Conditions	Conditions
LASIK	Usually not	Usually not	Usually not	Usually not

Home, long-term & end-of-life care

Home health, skilled nursing, nursing homes, and hospice.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Home health care	Conditions	Usually	Usually	Usually
Skilled nursing facility	Conditions	Conditions	Conditions	Usually
Nursing home & long-term care	Usually not	Usually not	Usually not	Conditions
Hospice care	Usually	Usually	Usually	Usually

Weight, lifestyle & everything else

Weight-loss surgery and counseling, cosmetic procedures, travel, and out-of-network care.

Benefit	Job / Marketplace	Original Medicare	Medicare Advantage	Medicaid
Nutrition counseling	Conditions	Conditions	Conditions	Conditions
Out-of-network care	Conditions	Usually	Conditions	Usually not
Care outside the U.S.	Conditions	Usually not	Conditions	Usually not
Exams and tests for work or legal reasons	Usually not	Usually not	Usually not	Usually not
Weight-loss surgery	Conditions	Conditions	Conditions	Conditions
Cosmetic surgery	Usually not	Usually not	Usually not	Usually not
Gender-affirming care	Depends	Conditions	Conditions	Depends
Clinical trials	Conditions	Conditions	Conditions	Conditions
Gym, fitness, and weight-loss programs	Usually not	Usually not	Usually	Usually not
Rides to medical appointments	Usually not	Usually not	Usually not	Usually

What health insurance covers

Preventive care & screenings

Preventive care & screenings · 12

Doctor visits & urgent care

Doctor visits & urgent care · 9

Tests & imaging

Tests & imaging · 13

Hospital & surgery

Hospital & surgery · 7

Pregnancy, fertility & family

Pregnancy, fertility & family · 9

Mental health & substance use

Mental health & substance use · 8

Rehab & alternative care

Rehab & alternative care · 7

Prescription drugs

Prescription drugs · 12

Medical equipment & supplies

Medical equipment & supplies · 12

Dental, vision & hearing

Dental, vision & hearing · 8

Home, long-term & end-of-life care

Home, long-term & end-of-life care · 4

Weight, lifestyle & everything else

Weight, lifestyle & everything else · 10