What does Medicare cover?

Published 04/07/2008 07:58 AM   |    Updated 04/07/2008 07:59 AM

What does Medicare cover?

Medicare helps pay for certain health care services and durable medical equipment.  To have full Medicare coverage, Medicare beneficiaries must have Part A (Hospital Insurance) and Part B (Medical Insurance). 

The following is a partial list of Medicare-covered services.  The covered services listed below may require payment of deductibles and copayments.  If you have questions about covered services, call Medicare at 1-800-633-4227. 


PART A COVERAGE

Inpatient Hospital Care

  • Semi-private room and board
  • Special care units, such as intensive care
  • Nursing services
  • Drugs administered by the hospital during the stay
  • Lab tests
  • Radiology  services
  • Medical supplies
  • Operating and recovery room costs
  • Rehabilitation services
  • Blood transfusions

Inpatient Skilled Nursing Facility Care

  • Semi-private room and board
  • Nursing services
  • Physical, occupational, and speech therapy services
  • Medical  equipment and supplies furnished by the skilled nursing facility during the stay
  • Drugs administered by the skilled nursing facility during the stay

Inpatient psychiatric care

  • Psychiatric care in a general hospital is treated the same as other inpatient hospital care.  (See above)
  • For care in a freestanding psychiatric hospital, Medicare pays for no more than 190 days of inpatient care.

Home Health Care

  • Part-time or intermittent skilled nursing care
  • Physical and speech therapy (limits)
  • Medical social services
  • Medical supplies
  • Durable medical equipment
  • Hospice Care

    • Doctor and nursing services
    • Home health aide and homemaker services
    • Short term inpatient care
    • Medical supplies
    • Physical, occupational, and speech therapy
    • Drugs (to manage symptoms and pain)
    • Family counseling
    • Medical social services
    • Inpatient respite care (to provide relief for the person who normally provides care--five day maximum stay)

    PART B COVERAGE

    • Physician services received in the doctor's office, patient's home, hospital, skilled nursing facility, or anywhere else in the United States
    • Medical and surgical services, including anesthesia (inpatient and outpatient)
    • Radiology and pathology services (inpatient and outpatient)
    • X-rays
    • Medical supplies
    • Blood transfusions (after first three pints)
    • Laboratory tests billed by the hospital
    • Ambulance coverage
    • Drugs and biologicals which cannot be self administered
    • Outpatient hospital services
    • Outpatient physical, occupational, or speech therapy
    • Outpatient maintenance dialysis
    • Community mental health services
    • Comprehensive outpatient rehabilitation services
    • Other services not covered by Part A

    PART B COVERAGE--PREVENTIVE SERVICES

    • Screening mammogram - Medicare will cover a diagnostic mammogram when the doctor has specific reasons for ordering the test or once a year.
    • Pap smear and pelvic exam (includes a clinical breast exam) once every two years or once every year if you are high risk
    • Colorectal cancer screening
    • Diabetes monitoring, includes coverage for glucose monitor, test strips, lancets, and self-management training
    • Flu shot once per year
    • Prostate cancer screening for men age 50 and older once every year (Blood test or digital rectal exam)
    • Bone density/osteoporosis screening (if at risk)
    • Pneumonia vaccine - Once per lifetime

    SERVICES NOT COVERED BY MEDICARE

    • Personal convenience items
    • Private duty nurse
    • Private room, unless it is medically necessary
    • Routine physical exams and tests related to exams
      • Routine foot care
      • Dental services
      • Cosmetic surgery
      • Exams for prescribing or fitting eyeglasses or hearing aids
      • Hearing aids or eyeglasses
      • Most immunizations
      • Most chiropractic services
      • Most prescription drugs
      • Custodial care
      • Medical devices not approved by the U.S. Food and Drug Administration
      • Nursery charges
    • Services rendered outside the United States (Canada and Mexico may be exceptions)
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