Medicare Coverage Explained

Medicare is a U.S. federal program available to individuals over 65 years of age to help them meet their medical needs. Here is some basic information about what is covered under Medicare Parts A and B — as well as coverage for rehabilitation and skilled nursing facilities.

Medicare Part A

Medicare Part A helps cover your inpatient care in hospitals, skilled nursing and rehab facilities. It also covers hospice care and some home health care.

The program is premium-free if you meet certain conditions. Individuals who don’t qualify can still get coverage for a monthly premium.

Medicare Part A Helps Cover

• Blood: Pints of blood given at a hospital or skilled nursing facility that accepts Medicare are covered during a stay.
• Home Health Care: Coverage includes durable medical equipment, home health aide services, medical social services, medical supplies, occupational therapy, part-time skilled nursing care, physical therapy, speech-language therapy and other services. Care must be prescribed by a physician. Unskilled companion care is not covered.
• Hospice Care: Drugs for symptom control and pain relief, medical and support services given by a Medicare-approved hospice and other services are covered. Hospice care is usually given in your home, but short-term hospital and inpatient respite care are covered when needed.
• Hospital Stays: General nursing, hospital services and supplies, meals and a semi-private room are covered. This does not include private duty nursing, a private room or a telephone or television in your room unless it’s medically necessary.
• Inpatient Rehabilitation Facility (IRF): Care at Medicare-certified inpatient rehabilitation facilities is covered when a physician has prescribed acute rehabilitation for at least two different types of therapy for at least three hours per day. Prior hospitalization is not required, though inpatient rehabilitation is rarely prescribed or required without it.
• Skilled Nursing Facility (SNF) Care: Meals, rehabilitative services, skilled nursing, a semi-private room and other services and supplies are covered, but only after a related three-day hospital stay. Assisted living and custodial care — which helps you with daily activities like bathing, eating and walking — are not covered by Medicare. Private pay, Medicaid or long-term insurance can help cover these costs instead.

Medicare Part B

Medicare Part B requires a monthly premium and helps cover medical expenses like doctors’ services, outpatient hospital care, occupational and physical therapists and some home health care.

Medicare Part B Helps Cover

• Blood: Pints of blood you get as an outpatient or as part of a Part B covered service.
• Clinical Laboratory Services: Blood tests, urinalysis and more.
• Home Health Care: Durable medical equipment, home health aide services, medical social services, medical supplies, occupational and physical therapy, part-time skilled nursing care, speech-language therapy and other services.
• Medical and Other Services: Ambulatory surgery center facility fees for approved procedures, diagnostic tests, Doctors’ services (not routine physical exams), durable medical equipment and outpatient medical and surgical services and supplies are covered. Part B also covers outpatient mental health care, outpatient occupational, physical and second surgical opinions and speech-language therapy.
• Outpatient Hospital Services: Hospital services and supplies received as an outpatient as part of a doctor’s care.

Medicare Also Helps Cover

• Ambulance services (when other transportation would endanger your health)
• Artificial eyes, prosthetic limbs and their replacement parts
• Braces (arm, back, leg and neck)
• Chiropractic services to correct a subluxation
• Emergency care
• Eyeglasses (one pair of standard frames after cataract surgery with an intraocular lens)
• Immunosuppressive drug therapy for patients with transplants paid for by Medicare
• Kidney dialysis
• Macular degeneration of the eye
• Medical nutrition therapy services for people with diabetes or kidney disease with a doctor’s referral
• Medical supplies (items such as casts, some diabetic supplies, ostomy bags, splints and surgical dressings)
• 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, nurse practitioners and physician assistants
• Telemedicine services in some rural areas
• Therapeutic shoes for people with diabetes (in some cases)
• Transplants (bone marrow, cornea, heart, intestine, kidney, liver, lung and pancreas under certain conditions and when performed at approved facilities)
• CAT scans, EKGs, MRIs, x-rays and some other diagnostic tests

Medicare Health Plans (like an HMO) may include extra benefits such as dental care, prescription drugs and routine physical and vision services.