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What types of services are covered under Medicare?

Medicare Part A

Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also covers hospice care and some home health care. You must meet certain conditions.

Medicare Part A Helps Cover Your:

Hospital Stays: Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes care you get in critical access hospitals and inpatient mental health care. This does not include private duty nursing, or a television or telephone in your room. It also does not include a private room, unless medically necessary.

Skilled Nursing Facility Care: Semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day hospital stay).

Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services.

Hospice Care: Medical and support services from a Medicare-approved hospice for people with a terminal illness, drugs for symptom control and pain relief, and other services not otherwise covered by Medicare. Hospice care is given in your home. However, short-term hospital and inpatient respite care (care given to a hospice patient by another caregiver so that the usual caregiver can rest) are covered when needed.

Blood: Pints of blood you get at a hospital or skilled nursing facility during a covered stay.

Medicare Part B

Medicare Part B (Medical Insurance) helps cover your doctors’ services, outpatient hospital care, and some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. You pay the Medicare Part B premium.

Medicare Part B Helps Cover Your:

Medical and Other Services: Doctors’ services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speech-language therapy.

Clinical Laboratory Services: Blood tests, urinalysis, and more.

Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services.

Outpatient Hospital Services: Hospital services and supplies received as an outpatient as part of a doctor’s care.

Blood: Pints of blood you get as an outpatient or as part of a Part B covered service.

Medicare Also Helps Cover:

  • Ambulance services (when other transportation would endanger your health).
  • Artificial eyes.
  • Artificial limbs that are prosthetic devices, and their replacement parts.
  • Braces – arm, leg, back, and neck.
  • Chiropractic services (limited), for manipulation of the spine to correct a subluxation.
  • Emergency care.
  • Eyeglasses – one pair of standard frames after cataract surgery with an intraocular lens.
  • Immunosuppressive drug therapy for transplant patients as long as you are covered by Medicare (transplant must have been paid for by Medicare).
  • Kidney dialysis.
  • Macular degeneration of the eye (“wet” age-related) treatment, using ocular photodynamic therapy with verteporfin.
  • Medical nutrition therapy services for people with diabetes or kidney disease with a doctor’s referral.
  • Medical supplies – items such as ostomy bags, surgical dressings, splints, casts, and some diabetic supplies.
  • Outpatient prescription drugs (very limited). For example, some oral drugs for cancer.
  • Preventive services.
  • Prosthetic devices, including breast prosthesis after mastectomy.
  • Second opinion by a doctor (in some cases).
  • Services of practitioners such as clinical social workers, physician assistants, and nurse practitioners.
  • Telemedicine services in some rural areas.
  • Therapeutic shoes for people with diabetes (in some cases).
  • Transplants – heart, lung, kidney, pancreas, intestine, bone marrow, cornea, and liver (under certain conditions and when performed at approved facilities).
  • X-rays, MRIs, CAT scans, EKGs, and some other diagnostic tests.

What is not paid for by Medicare Part A and Part B:

The Original Medicare Plan does not cover everything. Health care costs not covered by Medicare will include, but are not limited to:

  • Acupuncture.
  • Deductibles, coinsurance, or copayments when you get health care services.
  • Dental care and dentures (in most cases).
  • Cosmetic surgery.
  • Custodial care (help with bathing, dressing, using the bathroom,and eating) at home or in a nursing home.
  • Health care you get while traveling outside of the United States (except in limited cases).
  • Hearing aids and hearing exams.
  • Orthopedic shoes.
  • Outpatient prescription drugs (with only a few exceptions).
  • Routine foot care (with only a few exceptions).
  • Routine eye care and most eyeglasses (see exception above for one pair of standard frames after cataract surgery with an introcular lens).
  • Routine or yearly physical exams.
  • Certain screening tests
  • Certain shots (vaccinations)
This article was published on Friday 16 November, 2012.
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