Medicare Benefits

Medicare Benefits

What Medicare Covers

Medicare Parts A and B are often referred to as “Original” Medicare, which pays health care expenses for people who are age 65 and older.

Medicare Part A and B cover very specific healthcare needs:

  • Medicare Part A (Hospital Insurance), covers inpatient hospital visits, skilled nursing facility stays, home health care and hospice care.
  • Medicare Part B (Medical Insurance), covers certain amenities from the doctor such as outpatient care, preventative amenities and medical supplies.

Outpatient Care Services Covered by Medicare

Medicare Part B will cover outpatient services from your hospital as long as the diagnostic and treatment services are deemed medically necessary. Outpatient services covered may include the following:

  • Certain Medical supplies
  • Emergency room or observation services
  • Partial hospitalization for mental health services
  • Select drugs and biologicals that are by a rule administered by a healthcare professional.
  • Preventive and screening services
  • Procedures in an outpatient facility also to include same day surgery
  • Test done in a lab which are billed by the hospital

Preventative Screening Covered by Medicare

Medicare Part B covers many preventive screenings and services at no cost to beneficiaries. Copays, coinsurance and deductibles are waived for the following preventive screenings services:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse screenings & counseling
  • Bone mass measurement (bone density)
  • Cardiovascular disease screenings
  • Cardiovascular disease (behavioral therapy)
  • Cervical & vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes self-management training
  • Glaucoma testing’s
  • Hepatitis C screening test
  • HIV screening
  • Lung cancer screening
  • Mammogram screenings
  • Nutrition therapy services
  • Obesity screenings & counseling
  • “Welcome to Medicare” preventive visit (one-time service)
  • Prostate cancer screenings
  • Sexually transmitted infections screening & counseling
  • Tobacco use cessation counseling
  • Yearly Wellness visit
  • Shots:
    • Flu Shots
    • Hepatitis B shots
    • Pneumococcal shots

Doctor Visits with Medicare

Doctor visits are covered with Medicare Part B (Medical Insurance), this also includes preventive tests from your doctor that are deemed medically necessary.

Services provided by alternative healthcare providers will also be covered by Medicare such as:

  • Physician assistants
  • Nurse practitioner
  • Clinical nurse specialist
  • Clinical social worker
  • Physical and occupational therapist
  • Speech pathologist
  • Clinical psychologist

Medicare Related Costs

As a rule, you do not pay a monthly premium for Medicare Part A if you and or your spouse have paid Medicare taxes while working. This is often referred to as “premium-free Part A.”

If you do not qualify for premium-free Part A, you may be eligible to purchase Part A if:

  • You are age 65 or older and you have Medicare Part B.
  • You are under age 65 and have a disability and your premium-free Part A coverage ended as a result of you returning to work.

If you purchase Part A, you will pay up to $413 per month (2017). In most instances, if you have chosen to purchase Part A, you must also have Part B and pay a monthly premium for both.

Medicare Part B beneficiaries will pay 20% of the approved Medicare amount with the exception of certain preventive services.

Services Not Covered by Medicare

Original Medicare does not provide coverage for all medical services. There are some services that you will need to either have a private insurance plan or a supplemental coverage (link to medicare supplement content page) for.

Here’s a list of healthcare services not covered by Medicare:

  • Acupuncture or Alternative Medicine
  • Cosmetic Services or Surgery
  • Long-term Custodial Care
  • Most Prescription or Over-The-Counter Drugs
  • Most Treatments Received Outside of the U.S.
  • Routine Foot Care
  • Routine Vision, Dental or Hearing Care

FAQs

What diabetic supplies and services does Medicare cover?

Medicare Part B will cover some diabetic supplies and services. The following is a list of covered diabetic supplies:

  • Blood sugar test strips
  • Blood sugar testing monitors
  • Glucose control solutions
  • Insulin
  • Lancets and lancet devices
  • Therapeutic shoes and inserts

The following is a list of covered diabetic services:

  • Diabetes self-management training
  • Yearly eye exam
  • Foot exam
  • Glaucoma tests
  • Nutrition therapy services
Will Medicare cover transportation to my doctor?

As a rule, Medicare does not cover transportation for a doctor’s visit however; Medicare insurance depends on the severity of your medical condition and whether you could have been transported by other means.

Are ambulance services covered by Medicare?

Under Medicare Part B ambulance services to the nearest medical facility (hospital or skilled nursing facility) is covered.

Will Medicare cover me on travel outside of the United States?

Original Medicare does not extend coverage outside of the United States. You will be responsible for 100% of your medical expenses while traveling abroad.

Does Medicare cover chiropractic services?

Under Medicare Part B chiropractic services are covered if medically necessary, which includes manual manipulation of the spine to correct subluxation when provided by a chiropractor or qualified provider.

Does Medicare cover mental health care?

Outpatient mental health care services are covered under Medicare Part B as well as visits to a psychiatrist, clinical psychologist, clinical social worker, clinical nurse specialist, nurse practitioner and a physician assistant.

Medigap covers cost that original Medicare Doesn’t