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The care system is made up of distinct settings — each with its own team, its own rules, and its own role in your journey. Select where you are or where you're headed.
1Your state
2Your coverage type
Coverage information is sourced from CMS.gov and federal Medicare statute. State Medicaid benefit data reflects KFF State Health Facts, which is compiled from CMS-approved state Medicaid plans. Medicare Advantage supplemental benefits (dental, hearing, vision) vary by plan — CMS does not standardize these benefits and indicators marked "may be covered" require verification with your specific plan's Evidence of Coverage document. This tool provides general guidance only and is not a coverage determination. Always verify your specific benefits with your insurer or state Medicaid agency. Source data: CMS Medicare Coverage Database · KFF State Health Facts · Medicare.gov
Coverage
Covered
May be covered — verify your plan
Not covered
Select a setting above to see who's there, what they control, and how to navigate it.
Coverage questions while you navigate?
Understanding what Medicare and Medicaid cover in each setting changes how you work with every team on this page.
More resources
Insurance & benefits
Understanding Coverage
Medicare parts, Medigap, prior authorization, denials and appeals.
Equipment & Medications
Medical Equipment
What qualifies, what's covered, how to get it, and supplier rights.
Supplies & Medications
Prescriptions & Pharmacy
Part D, formularies, Extra Help, and what your pharmacist can do.
The bigger picture
The Care Journey
The full arc from Medicare enrollment through long-term care.
Data sources & methodology
Medicare coverage data
CMS Medicare Benefit Policy Manual (IOM Pub 100-02) · 42 CFR Part 410 · Social Security Act §§1861–1862 · CMS Medicare & You 2025 · CMS Medicare Advantage and Part D Final Rule (42 CFR Parts 417, 422, 423). Coverage determinations reflect Original Medicare policy. Medicare Advantage coverage varies by individual plan.
State Medicaid benefit data
KFF State Health Facts — Medicaid Benefits indicators (kff.org/state-health-facts) · ADA State Dental Policy Report 2025 · Health Affairs doi:10.1377/hlthaff.2023.00873. Dental, hearing, and vision coverage by state reflects KFF indicator and ADA 2025 data. KFF notes some indicators are approximate — verify with your state Medicaid agency. Data reflects 2025 benefit packages.
Coverage confidence levels
High confidence: Medicare coverage categories (federal statute). Dental, hearing, and vision by state for Medicaid (KFF/ADA sourced).
Moderate confidence: Medicaid coverage for other service categories (state plan variation is significant).
Verify directly: Medicare Advantage plan-specific coverage · state Medicaid managed care contracts · specific prior authorization requirements.
Moderate confidence: Medicaid coverage for other service categories (state plan variation is significant).
Verify directly: Medicare Advantage plan-specific coverage · state Medicaid managed care contracts · specific prior authorization requirements.
This page provides general guidance only and does not constitute a coverage determination. Eligibility depends on individual clinical circumstances, plan enrollment, and state Medicaid agency decisions. Last updated April 2026. If you believe any information is inaccurate, let us know.