Quiet Giant Medicare
(888) 555-0142 Speak to an advisor

Coverage policy

What Medicare has already decided to cover

Before any plan is chosen, Medicare itself has published rules about whether an item or service is reasonable and necessary — nationally, and jurisdiction by jurisdiction. This searches those rules directly, from the Centers for Medicare and Medicaid Services.

The checker

Search the Medicare Coverage Database

Type what you are looking for, then narrow it to the contractors that write policy where you live.

Try
Status
Document type

Loading the Medicare Coverage Database…

    Read this before you rely on it

    Coverage policy is not a benefits check

    What a determination actually is

    A National Coverage Determination is Medicare's own decision about whether an item or service is covered, and it binds every contractor in every state. There are 345 of them.

    A Local Coverage Determination is written by the Medicare Administrative Contractor for a jurisdiction, and it applies only there. That is the whole reason this page has a state filter: the same wheelchair, the same genetic test, the same wound dressing can be covered in one state and not in the next.

    Neither is a guarantee of payment. Coverage policy says under what circumstances something is considered reasonable and necessary. What you pay depends on your plan, your county, your diagnosis and the documentation your clinician files.

    Why the retired flag is shouted

    116 of the 977 local determinations in this set have been retired. They are still indexed by search engines, still quoted in forums and still linked from articles that were right when they were written. A retired policy is the most common source of confidently wrong Medicare advice we see, so every retired row on this page says so before it says anything else.

    Two things this page cannot do, said plainly

    • It cannot price anything. The Coverage API carries no premiums, no deductibles and no plan search, and there is no public Medicare plan-premium API anywhere. Any site showing you a live Medicare premium is showing you a number it made up or scraped.
    • It cannot pin a local policy to your jurisdiction. The report names the contractor and not the jurisdiction, and five contractors hold two jurisdictions each. Filtering by state narrows 977 policies to the contractors that serve you; opening the official document tells you exactly where it applies.

    Source: Centers for Medicare and Medicaid Services, Medicare Coverage Database API, api.coverage.cms.gov/v1/reports. Fetched server-side and cached; searched in your browser. Start a plan review · Compare the four plan families