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 1-800-622-4792.
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)