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. Read
Medicare and Your Mental Health Benefits for more information on
inpatient mental health benefits.
Skilled Nursing Facility Care: Semiprivate
room, meals, skilled nursing and rehabilitative services, and other services
and supplies (after a related 3-day hospital stay). Read Medicare Coverage of
Skilled Nursing Facility Care for more information.
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. Read Medicare and Home Health Care for more information.
Hospice Care: Medical 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. If you are living in a nursing home,
hospice does not pay for the cost of room and board. 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.
Read Medicare Hospice Benefits for more
information.
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
doctor's 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 therapist, 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 of $58.70 per month in 2003.
Medicare Part B Helps Cover Your:
Medical and Other Services: Doctor's services
(not routine physical exams), outpatient medical and surgical services and
supplies, diagnostic test, 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. Read Medicare and Your Mental Health Benefits and
Getting a Second Opinion Before Surgery for more information.
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. Read Medicare and Home Health Care for more information.
Outpatient Hospital Services: Hospital
services and supplies received as an outpatient as part of a doctor's care. Read
Your Guide to the Outpatient Prospective Payment System for more
information.
Blood: Pints of blood you get as an
outpatient or as part of a Part B covered service.
Medicare Also Helps Cover:
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Ambulance services (when other transportation would
endanger your health).
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Artificial eyes.
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Artificial limbs that are prosthetic devices, and
their replacement parts
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Braces - arm, leg, back, and neck.
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Chiropractic services (limited), for manipulation of
the spine to correct a subluxation.
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Emergency care
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Eyeglasses - one pair of standard frames after
cataract surgery with an intraocular lens.
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Immunosuppressive drug therapy for transplant
patients as long as your are covered by Medicare (transplant must have been
paid for by Medicare).
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Kidney dialysis. Read Medicare Coverage of Kidney
Dialysis and Kidney Transplant Services for more information.
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Macular degeneration of the eye ("wet": age-related)
treatment, using ocular photodynamic therapy with verteporfin.
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Medical nutrition therapy services for people with
diabetes or kidney disease with a doctor's referral.
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Medical supplies - items such as ostomy bags,
surgical dressings, splints, casts, and some diabetic supplies.
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Outpatient prescription drugs (very limited). For
example, some oral drugs for cancer
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Preventive services. Read Medicare Preventive
Services to Keep You Healthy or Women with Medicare - Visiting Your Doctor for
a Pap Test, Pelvic Exam, and Clinical Breast Exam for more information.
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Prosthetic devices, including breast prosthesis after
mastectomy.
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Second opinion by a doctor (in some cases). Read
Getting a Second Opinion Before Surgery for more information.
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Services of practitioners such as clinical social
workers, physician assistants, and nurse practitioners.
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Telemedicine services in some rural areas.
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Therapeutic shoes for people with diabetes (in some
cases)
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Transplants - heart, lung, kidney, pancreas,
intestine, bone marrow, cornea, and liver (under certain conditions and when
performed at approved facilities).
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X-rays, MRIs, CAT scans, EKGs and some other
diagnostic tests.
What is not paid for by Medicare Part A
and Part B:
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The Original Medicare Plan does not cover everything.
Health care costs not covered by Medicare will include, but are not limited to
:
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Acupuncture
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Deductibles, coinsurance, or copayments when you get
health care services.
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Dental care and dentures (in most cases).
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Cosmetic surgery
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Custodial care (help with bathing, dressing, using
the bathroom, and eating) at home or in a nursing home.
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Health care you get while travelling outside of the
United States (except in limited cases).
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Hearing aids and hearing exams
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Orthopedic shoes
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Outpatient prescription drugs (with only a few
exceptions).
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Routine foot care (with only a few exceptions).
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Routine eye care and most eyeglasses (see exception
above for one pair of standard frames after cataract surgery with an introcular
lens).
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Routine or yearly physical exams
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Screening tests except those listed in Medicare
Preventive Services to Keep You Healthy.
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Shots (vaccinations) except those listed in Medicare
Preventive Services to Keep You Healthy.
You may obtain further information at
http://www.medicare.gov
or call 1-800-633-4227
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