Medicare Part A

Medicare Part A helps cover the costs associated primarily with hospitalization. It includes coverage for the following expenses:

  • admitted hospital stays—after the payment of a deductible:
    • days 1 through 60—fully covered by Medicare
    • days 61 through 90—requires a daily co-pay by the beneficiary
    • days 91 through 150—requires a (larger) daily co-pay by the beneficiary
  • care in a skilled nursing facility—for a certain number of days, within certain requirements and limitations, and only for skilled care (The care must be associated with a prior hospitalization of at least three days, not counting the day of dismissal from the hospital, and the patient must have been “admitted” to the hospital, not classified as “under observation.”)
  • some home health care—again, within certain restrictions and requirements
  • hospice care—for a terminal patient, either at home or at a hospice facility
  • blood—a certain number of pints after a three-pint “deductible” received in a hospital or skilled nursing facility during a covered stay
  • some inpatient mental health care

Medicare Part B

Medicare Part B helps cover costs associated with outpatient health care and covers the following:

  • medical and other services, such as:
    • doctor’s services (excluding routine physical exams)
    • outpatient medical and surgical services and supplies
    • diagnostic tests
    • urgently needed care
    • X-rays, CAT scans, EKGs, lab tests, HIV screenings, and pulmonary rehabilitation
    • ambulatory surgery center facility fees for approved procedures and outpatient chemotherapy
    • ambulance transportation for medically necessary services when other transportation would endanger the insured’s health, including air transportation when ground transportation is not available to the closest health care facility
    • physical, occupational, and speech therapy
    • durable medical equipment, such as wheelchairs, hospital beds, oxygen, and walkers
    • medical supplies
    • second surgical opinions
    • outpatient mental health care (which since 2010 is more in line with Part B medical benefits)
    • outpatient physical and occupational therapy, including speech-language therapy
    • drugs that are administered in an outpatient hospital setting or doctor’s office
  • clinical laboratory services—blood tests, urinalysis, and more
  • home health care—within certain requirements and limitations for costs not covered by Part A, and for medically necessary and skilled nursing care or medical social services
  • outpatient hospital services—hospital services and supplies received as an outpatient, under a doctor’s care
  • blood—pints of blood received as an outpatient or as part of a Part B covered service, with a three-pint deductible and a 20 percent co-pay for additional pints
  • prosthetic devices, including artificial limbs and eyes, and their replacement parts, including arm, neck, and leg braces
  • kidney dialysis, services and supplies, kidney disease education services, and kidney transplants
  • heart, liver, lung, pancreas, intestine, bone marrow, and cornea transplants under certain conditions and when performed at Medicare-certified facilities
  • certain preventive services:
    • bone mass measurements
    • correctional cancer screening and abdominal aortic aneurysm screening
    • diabetes services and supplies and foot exams and treatment for diabetes-related nerve damage and diabetes self-management training
    • glaucoma screening
    • mammogram screening and clinical breast exams
    • Pap test and pelvic examination, including cervical and vaginal cancer screenings
    • prostate cancer screening
    • vaccinations—shots for flu (one per season), pneumococcal pneumonia, and hepatitis B
    • cardiovascular screenings every five years to test cholesterol, lipid, and triglyceride levels
    • one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens
    • certain chiropractic services (subluxation)
    • medical nutrition therapy services