What Medicare Does and Does Not Cover

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  • Introduction

    Introduction

    Medicare pays for many of your health-care needs and expenses—but not everything. Knowing what’s covered and what isn’t can help you plan for unexpected costs and budget for your annual health-care expenses.

  • What Does Medicare Not Cover?

    What Does Medicare Not Cover?

    Medicare coverage doesn’t provide:

    • long-term care (also called custodial care), such as nursing home stays or stays in an assisted-living center
    • routine dental or eye care
    • dentures
    • cosmetic surgery
    • acupuncture
    • hearing aids and exams for fitting them

  • What Does Part A Cover?

    What Does Part A Cover?

    Medicare Part A covers your inpatient hospital stays.

    • You pay a deductible and no co-payment for days one to 60 each benefit period.
    • You pay a co-payment for days 61 to 90 each benefit period.
    • You pay a co-payment per “lifetime reserve day” after day 90 each benefit period (up to 60 days over your lifetime).
    • You pay all costs for each day after the lifetime reserve days.

    Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.

  • What Does Part A Cover? Continued

    What Does Part A Cover? Continued

    Medicare Part A will cover an inpatient stay in a skilled nursing facility—after you have stayed a minimum of three days in the hospital.

    • You pay nothing for the first 20 days each benefit period.
    • You pay a co-insurance per day for days 21 to 100 each benefit period.
    • You pay all costs for each day after day 100 in a benefit period.

  • What Does Part A Cover? Continued

    What Does Part A Cover? Continued

    Hospice care facilities

    • You pay nothing for hospice care.
    • You pay a co-payment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
    • •    You pay five percent of the Medicare-approved amount for inpatient respite care.

    Home health-care services

    • You pay nothing for covered home health-care services.
    • You pay 20% of the Medicare-approved amount for durable medical equipment.

  • What Does Part A Cover? Continued

    What Does Part A Cover? Continued

    Blood transfusions

    • You pay for the first three pints of blood if the hospital treating you had to buy the blood. It’s free if the blood was donated to the hospital or to you.

  • What Does Part B Cover?

    What Does Part B Cover?

    • Doctor’s appointments, including specialists. You pay 20 percent co-insurance.
    • Outpatient care, including outpatient hospital, medical, urgent care, tests, therapies, outpatient mental health, emergency, and ambulance services. You pay 20 percent co-insurance.
    • Home health services. This is limited to medically necessary part-time care. You pay 20 to 25 percent co-insurance.
    • Durable medical equipment. You pay a 20 percent co-insurance for items like oxygen, wheelchairs, and walkers.
      Preventive and screening services. You pay 25 percent co-insurance for some screenings.

  • Preventive and screening services covered by Medicare Part B

    Preventive and screening services covered by Medicare Part B

    Preventive and screening services covered by Medicare Part B

    • abdominal aortic aneurysm ultrasound
    • bone mass measurement (bone density)
    • mammograms
    • cardiovascular disease behavioral therapy
    • cervical and vaginal cancer screenings
    • colorectal cancer screenings
    • diabetes screening
    • glaucoma tests
    • hearing and balance exams
    • flu shot
    • hepatitis B shots
    • HIV screening
    • obesity screening and counseling
    • prostate cancer screenings
    • tobacco cessation therapy
    • yearly wellness visits

  • Emergency Services Covered by Medicare Part B

    Emergency Services Covered by Medicare Part B

    Medicare Part B covers ground ambulance transportation when you need to be taken to a hospital or emergency medical center. Medicare may also pay for emergency transportation in an airplane or helicopter if you need immediate and rapid transportation. You may have to pay a co-insurance payment on this service, however.

  • Supplies Covered by Medicare Part B

    Supplies Covered by Medicare Part B

    • diabetes self-management training
    • diabetes supplies
    • kidney dialysis services and supplies
    • transplants and immunosuppressive therapy

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