Medicare Coverage & Benefits Report

Anesthesia services (outside of the physician charges) are covered along with medical and surgical benefits. Medicare Part A covers anesthesia you get while in an inpatient hospital.

You pay 20% of Medicare-approved amounts.

Medicare will cover all but the first three pints of blood. Part A covers blood that you get as an inpatient.

You pay for the first 3 pints of blood, unless you or someone else donates blood to replace what you use.

Chemotherapy is covered for patients who are hospital inpatients or outpatients, and in freestanding clinics.

In the hospital setting, Part A covers Chemotherapy.

You pay 20% of Medicare-approved amounts.

Medicare covers routine costs, like doctor visits and tests if you take part in an qualifying clinical trial. Medicare does not pay for the experimental item being investigated in most cases. Clinical trials test new types of medical care, like how well a new cancer drug works. Clinical trials help doctors and researchers see if the new care works and if it is safe.

You pay the part of the charge that you would normally pay for a Medicare covered service or supply.

Medicare covers inpatient kidney dialysis treatments (if you are admitted to a hospital for special care).

You pay for each benefit period in 2003: Days 1 - 60: an initial deductible of $840 Days 61 - 90: $210 each day Days 91 - 150: $420 each day

Effective January 1, 2004: The amounts you pay for each benefit period will increase to the following amounts: Days 1 - 60: an initial deductible of $876. Days 61 - 90: $219 each day. Days 91 - 150: $438 each day.

A benefit period begins the day you go to a hospital (or under special circumstances, a skilled nursing facility). The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have.

Home Health Care is skilled nursing care and certain other health care services you get in your home for the treatment of an illness or injury. Medicare covers some home health care if:

1. Your doctor decides you need medical care in your home, and makes a plan for your care at home, and

2. You need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services, or a continued need for occupational therapy, and

3. You are homebound. This means you are normally unable to leave home and that leaving home is a major effort. When you leave home, it must be infrequent, for a short time. You may attend religious services. You may leave the house to get medical treatment, including therapeutic or psychosocial care. You can also get care in an adult day-care program that is licensed or certified by a state or accredited to furnish adult day care services in a state, and

4. The home health agency caring for you must be approved by the Medicare program.

You pay $0 for all covered home health visits.

Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. The goal of hospice is to care for you and your family, not to cure your illness.

Medicare covers hospice care if:

Medicare will still pay for covered services for any health problems that are not related to your terminal illness.

Respite Care: Medicare also covers respite care if you are getting covered hospice care. Respite care is inpatient care given to a hospice patient so that the usual caregiver can rest. You can stay in a Medicare-approved facility, such as a hospice facility, hospital or nursing home, up to 5 days each time you get respite care. There is no limit to the number of times you can get respite care. The amount you pay for respite care can change each year.

You pay $0 for hospice care.

You pay a copayment of up to $5 for outpatient prescription drugs.

Room and board is generally not payable by Medicare, except in certain cases. For example, if you get general hospice services while you are a resident of a nursing home or a hospice's residential facility. However, room and board are covered for inpatient respite care and during short-term hospital stays.

You pay 5% of the Medicare-approved amount for inpatient respite care. The amount you pay for respite care can change each year.

Medicare Part A covers inpatient hospital care if all of the following is true:

Medicare covered hospital services include: A 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.

You pay for each benefit period in 2003: Days 1 - 60: an initial deductible of $840 Days 61 - 90: $210 each day Days 91 - 150: $420 each day

Effective January 1, 2004: The amounts you pay for each benefit period will increase to the following amounts: Days 1 - 60: an initial deductible of $876. Days 61 - 90: $219 each day. Days 91 - 150: $438 each day.

A benefit period begins the day you go to a hospital (or under special circumstances, a skilled nursing facility). The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have.

Lifetime reserve days give you an extra 60 days of inpatient coverage when you are in a hospital for more than 90 days. These 60 reserve days can be used only once during your lifetime.

Medicare covers mental health care furnished by a doctor or health care professional who can be paid by Medicare. Ask your doctor, psychologist, social worker, or other health professional if they accept Medicare payment before you get treatment.

Inpatient Mental Health Care: Medicare covers inpatient mental health care services given in a hospital that requires a hospital stay. These services can be given in a general hospital, or in a specialty psychiatric hospital that only cares for people with mental health problems. Regardless of which type of hospital you choose, Medicare Part A helps pay for mental health services in the same way as it does for any other Medicare inpatient hospital care. If you are in a specialty psychiatric hospital, Medicare Part A helps pay up to 190 days of inpatient care in a Medicare-certified psychiatric facility during your lifetime. You may get care, including psychiatric services, in general hospitals after you reach the 190-day lifetime limit in specialty psychiatric hospitals.

You pay the same initial deductible and copayments as inpatient hospital care, except there is a 190-day lifetime limit in a psychiatric hospital.

Radiation therapy is covered for patients who are hospital inpatients or outpatients, and in freestanding clinics.

In the hospital setting, Part A covers radiation therapy.

You pay 20% of Medicare-approved amounts.

Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. The goal of hospice is to care for you and your family, not to cure your illness.

Medicare covers hospice care if:

Medicare will still pay for covered services for any health problems that are not related to your terminal illness.

Respite Care: Medicare also covers respite care if you are getting covered hospice care. Respite care is inpatient care given to a hospice patient so that the usual caregiver can rest. You can stay in a Medicare-approved facility, such as a hospice facility, hospital or nursing home, up to 5 days each time you get respite care. There is no limit to the number of times you can get respite care. The amount you pay for respite care can change each year.

You pay $0 for hospice care.

You pay a copayment of up to $5 for outpatient prescription drugs.

Room and board is generally not payable by Medicare, except in certain cases. For example, if you get general hospice services while you are a resident of a nursing home or a hospice's residential facility. However, room and board are covered for inpatient respite care and during short-term hospital stays.

You pay 5% of the Medicare-approved amount for inpatient respite care. The amount you pay for respite care can change each year.

Medicare covers skilled care in a skilled nursing facility (SNF) under certain conditions for a limited time. Skilled care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Examples of skilled care include changing sterile dressings and physical therapy. It is given in a Medicare-certified SNF. Care that can be given by non-professional staff is not considered skilled care. Medicare covers certain skilled care services that are needed daily on a short-term basis (up to 100 days).

Medicare will cover skilled care only if all these conditions are met:

Please refer to the coverage information under Home Health Care for information about skilled nursing care given by a Home Health Agency in your home.

You pay the amounts below for each benefit period in 2003 following at least a 3-day covered hospital stay: Days 1 - 20: $0 for each day. Days 21 - 100: $105.00 for each day. Days over 101: You pay 100%.

There is a limit of 100 days of Medicare Part A SNF coverage in each benefit period.

Effective January 1, 2004 the amounts you pay for each benefit period will increase to the following amounts: Days 1 - 20: $0 for each day. Days 21 - 100: $109.50 for each day. Days over 101: You pay 100%.

A benefit period begins the day you go to a hospital (or under special circumstances, a skilled nursing facility). The benefit period ends when you have not received any hospital (or skilled care in a SNF) for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have.

Medicare covers transplants of the heart, lung, kidney, pancreas, intestine/multivisceral, and liver under certain conditions and, for some types of transplants, only at Medicare-approved facilities. Medicare only approves facilities for kidney, heart, liver, and intestine/multivisceral transplants. Pancreas transplants are not limited to approved facilities. Transplant coverage includes necessary tests, labs, and exams before surgery for you and the organ donor, follow-up care for you and a live donor, and procurement of organs and tissues.

Call your Fiscal Intermediary for information about heart, lung, kidney, pancreas, liver, and intestine/multivisceral transplants.

The Original Medicare Plan generally does not cover care outside the United States. Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands are considered part of the United States. There are some exceptions.

In rare cases, Medicare can pay for inpatient hospital services that you get in Canada or Mexico. Medicare can pay only if:

Medicare also pays for doctor and ambulance services furnished in Canada or Mexico in connection with a covered inpatient hospital stay.

Health care services and supplies are Not covered outside the United States except under limited circumstances.

You pay the part of the charge that you would normally pay for covered services.

Medicare pays for limited ambulance services. If you go to a hospital or skilled nursing facility (SNF), ambulance services are covered only if transportation in any other vehicle could endanger your health. Generally, transportation from a hospital or SNF is not covered. If the care you need is not available locally, Medicare helps pay for necessary ambulance transportation to the closest facility outside your local area that can provide the care you need. If you choose to go to another facility farther away, Medicare payment is based on how much it would cost to go to the closest facility. All ambulance suppliers must accept assignment.

Medicare does not pay for ambulance transportation to a doctor's office.

Air ambulance is paid only in emergency situations. If you could have gone by land ambulance without serious danger to your life or health, Medicare pays only the land ambulance rate and you are responsible for the difference.

You pay 20% of Medicare-approved amounts.

Anesthesia services (outside of the physician charges) are covered along with medical and surgical benefits. Medicare Part B covers anesthesia you get as an outpatient.

You pay 20% of Medicare-approved amounts.

Medicare covers prosthetic devices needed to replace a body part or function. These include Medicare-approved corrective lenses needed after a cataract operation, ostomy bags and certain related supplies, and breast prostheses (including a surgical brassiere) after a mastectomy.

Medicare also covers artificial limbs and eyes, and arm, leg, back, and neck braces. Medicare does not pay for orthopedic shoes unless they are a necessary part of the leg brace and the cost is included in the charge for the brace. Medicare does not pay for dental plates or other dental devices.

You pay 20% of Medicare-approved amounts.

Medicare will cover all but the first three pints of blood. Part B covers blood you get as an outpatient and in a freestanding Ambulatory Surgical Center.

You pay for the first 3 pints of blood, unless you or someone else donates blood to replace what you use.

Medicare covers bone mass measurement if you meet certain conditions: 1. This test must be ordered by a doctor or qualified practitioner who is treating you. 2. Every two years or more frequently if medically necessary. 3. You must meet one or more of the conditions below:

You pay 20% of Medicare-approved amounts.

Medicare covers arm, leg, back, and neck braces.

You pay 20% of Medicare-approved amounts.

Medicare covers breast prostheses (including a surgical brassiere) after a mastectomy.

You pay 20% of Medicare-approved amounts.

Medicare covers canes and crutches. Medicare does not cover white canes for the blind.

You pay 20% of Medicare-approved amounts.

Exercise programs are covered for patients referred by a doctor who have:

These programs may be given by the outpatient department of a hospital or in doctor-directed clinics.

You pay 20% of Medicare-approved amounts.

Chemotherapy is covered for patients who are hospital inpatients or outpatients, and in freestanding clinics.

In a freestanding facility, Chemotherapy is covered by Part B.

You pay 20% of Medicare-approved amounts.

Medicare covers manipulation of the spine to correct a subluxation, when provided by chiropractors or other qualified providers.

You pay 20% of Medicare-approved amounts.

Medicare covers routine costs, like doctor visits and tests if you take part in an qualifying clinical trial. Medicare does not pay for the experimental item being investigated in most cases. Clinical trials test new types of medical care, like how well a new cancer drug works. Clinical trials help doctors and researchers see if the new care works and if it is safe.

You pay the part of the charge that you would normally pay for covered services.

Medicare covers several colorectal cancer screening tests. Talk with your doctor about the screening options that are right for you. All people with Medicare age 50 and older are covered.

Barium Enema: Your Doctor can use this colorectal cancer screening test instead of a flexible sigmoidoscopy or colonoscopy.

You pay 20% of the Medicare-approved amount.

Medicare covers several colorectal cancer screening tests. Talk with your doctor about the screening options that are right for you. All people with Medicare age 50 and older are covered. However, there is no minimum age for having a colonoscopy.

Colonoscopy: Medicare covers this test once every 24 months if you are at high risk for colon cancer. If you are not at high risk for colon cancer,once every 10 years, but not within 48 months of a screening sigmoidoscopy.

You pay 20% of the Medicare-approved amount. You pay 25% of the Medicare-approved amount if the test is done in a hospital outpatient department.

Medicare covers several colorectal cancer screening tests. Talk with your doctor about the screening options that are right for you. All people with Medicare age 50 and older are covered.

Fecal Occult Blood Test: Medicare covers this test once every 12 months.

You pay nothing for a fecal occult blood test.

Medicare covers several colorectal cancer screening tests. Talk with your doctor about the screening options that are right for you. All people with Medicare age 50 and older are covered.

Flexible Sigmoidoscopy: Medicare covers this test once every 48 months, but not within 10 years of a screening colonoscopy.

You pay 20% of the Medicare-approved amount. You pay 25% of the Medicare-approved amount if the test is done in a hospital outpatient department.

Medicare covers durable medical equipment (DME) like commode chairs that your doctor orders for use in your home.

You pay 20% of Medicare-approved amounts.

A foot exam is covered every six months for people with diabetic peripheral neuropathy and loss of protective sensations, as long as you haven't seen a foot care professional for another reason between visits.

You pay 20% of Medicare-approved amounts.

Diabetes Self-Management Training: Diabetes outpatient self-management training is a covered program to teach you to manage your diabetes. It includes education about self-monitoring of blood glucose, diet, exercise, and insulin.

Training is covered if you are newly diagnosed with diabetes, or are newly eligible for Medicare, or are at significant risk for complications from the disease, and your doctor gives you a referral for this service. Medicare Part A covers training in an outpatient facility. Medicare Part B covers training from your doctor or other provider.

You pay 20% of Medicare-approved amounts for outpatient facility charges or doctors services.

Medicare covers some diabetic supplies for people with Medicare with diabetes (insulin users and non-insulin users).

These include limited quantities of:

Please refer to the coverage information under Durable Medical Equipment for information on blood glucose monitor coverage.

To make sure your Medicare diabetes medical supplies are covered:

Therapeutic Shoes: Medicare covers therapeutic shoes for people with diabetes who have severe diabetic foot disease. The doctor who treats your diabetes must certify your need for therapeutic shoes. The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist. Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year. Shoe modifications may be substituted for inserts.

The fitting of the shoes or inserts is covered in the Medicare payment for the shoes.

Insulin (unless used with an insulin pump), insulin pens, syringes, needles, alcohol swabs, gauze, eye exams for glasses, and routine or yearly physical exams are not covered.

You pay 20% of Medicare-approved amounts.

Medicare covers diagnostic tests like CT Scans, MRIs, EKGs, and X-rays. Diagnostic tests are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most routine screening tests.

Some preventive tests and screenings are covered by Medicare (for example, mammograms).

If the diagnostic tests or x-rays is performed at your physician's office or at a freestanding (independent) outpatient diagnostic testing facility: You pay 20% of Medicare-approved amounts for covered diagnostic tests and x-rays.

If the diagnostic tests or x-rays are performed at a hospital outpatient setting: You pay a set copayment amount for covered diagnostic tests and x-rays under the Outpatient Prospective Payment System (OPPS). The amount you pay depends on the diagnostic test you receive. Please contact the Medicare Carrier listed below for specific copayment amounts in your area.

Medicare covers Certain drugs for home dialysis, including heparin, the antidote for heparin when medically necessary, topical anesthetics, and Erythropoietin (Epogen or Epoetin alfa) injections.

If you deal with the dialysis facility, these drugs may be included in the cost of dialysis. If you deal with a supplier, you pay 20% of the Medicare-approved amount.

Medicare covers home dialysis equipment and supplies (like alcohol, wipes, sterile drapes, rubber gloves and scissors).

Generally, you pay 20% of the cost to buy or rent equipment and supplies. If you deal with a supplier (not the dialysis facility), the $100 deductible applies and your supplier must accept assignment.

Medicare covers certain home support services (may include visits by trained dialysis workers to check on your home dialysis, to help in emergencies when needed, and check your dialysis equipment and water supply).

You pay 20% of the cost. If you deal with a supplier (not the dialysis facility), the $100 deductible applies.

Medicare covers outpatient maintenance dialysis treatments (when you get treatments in any Medicare-approved dialysis facility).

You pay 20% of the per treatment rate.

Medicare covers self-dialysis training (includes training for you and for the person helping you with your home dialysis treatments).

You pay 20% of the training costs.

Medicare covers medically necessary services you get from your doctor in his or her office, in a hospital, in a skilled nursing facility, in your home, or any other location. Routine annual physicals and gynecological (GYN) exams are not covered

You pay 20% of Medicare-approved amounts.

Medicare covers durable medical equipment (DME) that your doctor prescribes for use in your home. Only your own doctor should prescribe medical equipment for you.

Durable Medical Equipment:

Covered Durable Medical Equipment includes, but is not limited to:

Make sure your supplier is enrolled by Medicare and has a Medicare supplier number. Suppliers have to meet strict standards to qualify for a Medicare supplier number. Medicare will not pay your claim if your supplier is not enrolled in Medicare and does not have a Medicare supplier number.

The amount you pay varies. Call your Medical Durable Equipment Carrier for more information. Medicare pays for different kinds of DME in different ways; some equipment must be rented, other equipment must be purchased, and for some equipment you may choose rental or purchase.

If a supplier of Durable Medical Equipment does not accept assignment, there is no limit to what can be charged. You also may have to pay the entire bill (your share and Medicare's share) at the time you get the Durable Medical Equipment. Always ask the supplier if they accept assignment. It could save you money.

A medical emergency is when you believe that your health is in serious danger. You may have a bad injury, sudden illness, or an illness quickly getting much worse.

Medicare covers emergency room services. Emergency services are not covered in foreign countries, except in some instances in Canada and Mexico. For more information, please refer to the Travel coverage information.

Emergency room visits usually include both facility charges and doctor?s charges.

Note: If you are admitted to the hospital within 1-3 days of the emergency room visit for the same condition, the emergency room visit is included in the inpatient hospital care charges, not charged separately.

You pay 20% of the facility charge or applicable copayment for each emergency room visit; you do NOT pay this amount if you are admitted to the hospital for the same condition within 1-3 days of the emergency room visit.

You pay 20% of doctor charges.

Following each cataract surgery with insertion of an intraocular lens, Medicare can help pay for one pair of conventional eyeglasses or contact lenses provided by a supplier that is authorized to provide such services in your state. Important:

You pay 20% of the Medicare-approved amount for one pair of ?standard frame? eyeglasses or contact lenses after each cataract surgery with an intraocular lens. If you choose to purchase ?upgraded frames,? you will pay any additional expenses associated with the ?upgraded frames.?

Medicare covers glaucoma screening, once every 12 months for people at high risk for glaucoma. This includes people with diabetes, a family history of glaucoma, or African-Americans who are age 50 or older. The screening must be done or supervised by an eye doctor who is legally allowed to do this service in your state.

You pay 20% of Medicare-approved amounts.

Medicare covers a treatment for "wet" age related macular degeneration with predominantly classic lesions. This treatment is called ocular photodynamic therapy with verteporfin.

You pay 20% of Medicare-approved amounts for diagnosis and treatment of diseases and conditions of the eye.

Medicare currently provides coverage for flu, pneumonia, and hepatitis vaccinations. Other types of vaccinations and immunizations are typically not covered by Medicare. Flu Shots: Medicare covers one flu shot a year, in the fall or winter. All people with Medicare are covered. Pneumoccal Pneumonia Shot: Medicare covers all people with Medicare for the Pneumococcal Pneumonia Shot (vaccine). One shot may be all you ever need, but you should discuss this with your doctor. Hepatitis B Shot: Medicare covers the Hepatitis B Shot (vaccine) for all people with Medicare who are are at medium to high risk for hepatitis B. You should discuss your risks for hepatitis B with your doctor.

You pay $0 for a flu shot if the doctor or health care provider accepts assignment. You pay $0 for pneumococcal pneumonia shots if your doctor or health care provider accepts assignment. You pay 20% of Medicare-approved amounts for the Hepatitis B vaccine given in a doctor's office. If the Hepatitis B Shot is given in a hospital outpatient department, you pay a set copayment amount. You pay 100% for all other immunizations and vaccinations.

Medicare generally does not cover routine foot care.

Medicare Part B covers the services of a podiatrist (foot doctor) for medically necessary treatment of injuries or diseases of the foot (such as hammer toe or bunion deformities and heel spurs).

For information about Therapeutic Shoes please refer to the coverage information listed under Diabetic Supplies.

You pay 100% for routine foot care.

You pay 20% of Medicare-approved amounts.

Medicare does not cover routine hearing exams or hearing aids.

In some cases, diagnostic hearing exams are covered by Part B.

You pay 100% for routine hearing exams and hearing aids.

You pay 20% of Medicare-approved amount for diagnostic hearing exams.

Medicare currently provides coverage for flu, pneumonia, and hepatitis vaccinations. Other types of vaccinations and immunizations are typically not covered by Medicare. Flu Shots: Medicare covers one flu shot a year, in the fall or winter. All people with Medicare are covered. Pneumoccal Pneumonia Shot: Medicare covers all people with Medicare for the Pneumococcal Pneumonia Shot (vaccine). One shot may be all you ever need, but you should discuss this with your doctor. Hepatitis B Shot: Medicare covers the Hepatitis B Shot (vaccine) for all people with Medicare who are are at medium to high risk for hepatitis B. You should discuss your risks for hepatitis B with your doctor.

You pay $0 for a flu shot if the doctor or health care provider accepts assignment. You pay $0 for pneumococcal pneumonia shots if your doctor or health care provider accepts assignment. You pay 20% of Medicare-approved amounts for the Hepatitis B vaccine given in a doctor's office. If the Hepatitis B Shot is given in a hospital outpatient department, you pay a set copayment amount. You pay 100% for all other immunizations and vaccinations.

Under Medicare's home health coverage, Medicare helps pay for an injectable drug for osteoporosis in women who are eligible for Medicare Part B, who meet the criteria for the Medicare home health benefit, and who have a bone fracture that a doctor certifies was related to post-menopausal osteoporosis. You must be certified by a doctor as unable to learn, or as physically or mentally incapable to give yourself the drug by injection, and that family and/or caregivers are unable or unwilling to give the drug.

Medicare also covers the visit by a home health nurse to administer the drug.

You pay 20% of the Medicare-approved cost of the drug.

You pay $0 for the visit by a home health nurse to administer the drug.

Medicare covers durable medical equipment (DME) that your doctor prescribes for use in your home. Only your own doctor should prescribe medical equipment for you.

Durable Medical Equipment:

Covered Durable Medical Equipment includes, but is not limited to:

Make sure your supplier is enrolled by Medicare and has a Medicare supplier number. Suppliers have to meet strict standards to qualify for a Medicare supplier number. Medicare will not pay your claim if your supplier is not enrolled in Medicare and does not have a Medicare supplier number.

The amount you pay varies. Call your Medical Durable Equipment Carrier for more information. Medicare pays for different kinds of DME in different ways; some equipment must be rented, other equipment must be purchased, and for some equipment you may choose rental or purchase.

If a supplier of Durable Medical Equipment does not accept assignment, there is no limit to what can be charged. You also may have to pay the entire bill (your share and Medicare's share) at the time you get the Durable Medical Equipment. Always ask the supplier if they accept assignment. It could save you money.

Medicare currently provides coverage for flu, pneumonia, and hepatitis vaccinations. Other types of vaccinations and immunizations are typically not covered by Medicare. Flu Shots: Medicare covers one flu shot a year, in the fall or winter. All people with Medicare are covered. Pneumoccal Pneumonia Shot: Medicare covers all people with Medicare for the Pneumococcal Pneumonia Shot (vaccine). One shot may be all you ever need, but you should discuss this with your doctor. Hepatitis B Shot: Medicare covers the Hepatitis B Shot (vaccine) for all people with Medicare who are are at medium to high risk for hepatitis B. You should discuss your risks for hepatitis B with your doctor.

You pay $0 for a flu shot if the doctor or health care provider accepts assignment. You pay $0 for pneumococcal pneumonia shots if your doctor or health care provider accepts assignment. You pay 20% of Medicare-approved amounts for the Hepatitis B vaccine given in a doctor's office. If the Hepatitis B Shot is given in a hospital outpatient department, you pay a set copayment amount. You pay 100% for all other immunizations and vaccinations.

Medicare covers medically necessary diagnostic lab services that are ordered by your treating doctor when they are provided by a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory that participates in Medicare. Diagnostic lab services are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most routine screening tests, like checking your cholesterol.

You pay $0 for Medicare-covered lab services.

Medicare covers a mammogram screening once every 12 months for all women with Medicare age 40 and older. You can also get one baseline mammogram between ages 35 and 39. The following Frequently Asked Question provides important information regarding how to calculate the 12 month period between mammograms: How does the Centers for Medicare & Medicaid Services (CMS) define the "12 month" rule for screening mammography eligibility?

Medicare covers new digital technologies for mammogram screenings.

You pay 20% of Medicare-approved amounts with no Part B deductible.

Medicare covers mental health care furnished by a doctor or health care professional who can be paid by Medicare. Ask your doctor, psychologist, social worker, or other health professional if they accept Medicare payment before you get treatment.

Outpatient Mental Health Care: Medicare covers mental health services when furnished on an outpatient basis by either a doctor, clinical psychologist, clinical social worker, clinical nurse specialist or physician assistant in an office setting, clinic, or hospital outpatient department.

Medicare covers substance abuse treatment in an outpatient treatment center that is certified by Medicare.

You usually pay 50% of Medicare-approved amounts.

Medicare covers mental health care furnished by a doctor or health care professional who can be paid by Medicare. Ask your doctor, psychologist, social worker, or other health professional if they accept Medicare payment before you get treatment.

Partial Hospitalization: Partial hospitalization for mental health care is a structured program of active treatment that is more intense than the care received in your doctor's or therapist's office. For Medicare to cover a partial hospitalization program, a doctor must say that you would otherwise need inpatient treatment.

You pay a set copayment amount for each day of service.

Medicare covers the services of specially qualified non-physician practitioners such as clinical psychologists, clinical social workers, nurse practitioners, clinical nurse specialists, physician assistants, certified registered nurse anesthetists, certified nurse midwives, and speech-language pathologists, as allowed by state and local law for medically necessary services.

You pay 20% of Medicare-approved amounts.

Medical nutrition therapy services are covered for people with diabetes, kidney disease (but not on dialysis), and after a transplant when referred by a doctor. These services can be given by a registered dietician or Medicare-approved nutrition professional and include nutritional assessment and counseling.

You pay 20% of Medicare-approved amounts.

Medicare helps pay for medically necessary outpatient physical and occupational therapy and speech pathology services when:

You can get these services as an outpatient of a participating hospital or skilled nursing facility, or from a participating home health agency, rehabilitation agency, or public health agency. Also, you can get services from a privately practicing, Medicare-approved physical or occupational therapist in his or her office or in your home. (Medicare may not pay for services given by privately practicing speech pathologists.)

You pay 20% of Medicare-approved amounts.

Medicare covers ostomy supplies for people who have a colostomy, ileostomy, or urinary ostomy. Medicare covers the amount of supplies your doctor says you need based on your condition.

You pay 20% of Medicare-approved amounts.

Medicare Part B covers medically necessary services you get as an outpatient from a Medicare-participating hospital for diagnosis or treatment of an illness or injury.

Covered outpatient hospital services include:

You pay 20% of Medicare-approved amounts for the doctor.

You pay a set copayment amount based on each service received.

Medicare covers rental of oxygen equipment, or if you own your own equipment, Medicare will help pay for oxygen contents and supplies for the delivery of oxygen under these conditions:

Medicare helps pay for:

If oxygen is provided only for use during sleep, portable oxygen would not be covered. Portable oxygen is not covered when provided only as a backup to a stationary oxygen system.

You pay 20% of the Medicare-approved amount.

Medicare covers Pap Tests and Pelvic Exams (and a clinical breast exam) for all women once every 24 months. If you are high risk for cervical or vaginal cancer, or if you are of childbearing age and have had an abnormal Pap Test, Medicare covers this test and exam once every 12 months. If you have your Pap Test, Pelvic Exam, and Clinical Breast Exam on the same visit as your physical exam, you pay for the physical exam. Routine physical exams are not covered by Medicare.

You pay $0 for the lab Pap Test.

You pay 20% of Medicare-approved amounts (or a copayment) for the part of the exam when the doctor or health care provider collects the specimen and for the pelvic exam.

If the pelvic exam was provided in a hospital outpatient department, you pay a set copayment amount.

Medicare helps pay for medically necessary outpatient physical and occupational therapy and speech pathology services when:

You can get these services as an outpatient of a participating hospital or skilled nursing facility, or from a participating home health agency, rehabilitation agency, or public health agency. Also, you can get services from a privately practicing, Medicare-approved physical or occupational therapist in his or her office or in your home. (Medicare may not pay for services given by privately practicing speech pathologists.)

You pay 20% of Medicare-approved amounts.

Medicare currently provides coverage for flu, pneumonia, and hepatitis vaccinations. Other types of vaccinations and immunizations are typically not covered by Medicare. Flu Shots: Medicare covers one flu shot a year, in the fall or winter. All people with Medicare are covered. Pneumoccal Pneumonia Shot: Medicare covers all people with Medicare for the Pneumococcal Pneumonia Shot (vaccine). One shot may be all you ever need, but you should discuss this with your doctor. Hepatitis B Shot: Medicare covers the Hepatitis B Shot (vaccine) for all people with Medicare who are are at medium to high risk for hepatitis B. You should discuss your risks for hepatitis B with your doctor.

You pay $0 for a flu shot if the doctor or health care provider accepts assignment. You pay $0 for pneumococcal pneumonia shots if your doctor or health care provider accepts assignment. You pay 20% of Medicare-approved amounts for the Hepatitis B vaccine given in a doctor's office. If the Hepatitis B Shot is given in a hospital outpatient department, you pay a set copayment amount. You pay 100% for all other immunizations and vaccinations.

Medicare does not cover most prescription drugs. Medicare covers a limited number of outpatient prescription drugs. Your pharmacy or doctor must accept assignment on Medicare-covered prescription drugs.

The following outpatient prescription drugs are covered:

Currently, Medicare covers the following oral cancer drugs:

As new cancer drugs and brand names become available, additional oral cancer drugs may be added to the list of covered drugs.

Medicare also covers some drugs used in infusion pumps and nebulizers if considered reasonable and necessary.

You pay 100% for most prescription drugs.

You pay 20% of the Medicare-approved amount for covered prescription drugs.

Medicare covers screening tests for all men with Medicare age 50 and older (coverage begins the day after the 50th birthday) once every 12 months. Covered tests include:

Generally, 20% of the Medicare-approved amount for the digital rectal exam.

You pay $0 for the PSA test and 20% of the Medicare-approved amounts for other related services.

Medicare covers prosthetic devices needed to replace a body part or function. These include Medicare-approved corrective lenses needed after a cataract operation, ostomy bags and certain related supplies, and breast prostheses (including a surgical brassiere) after a mastectomy.

Medicare also covers artificial limbs and eyes, and arm, leg, back, and neck braces. Medicare does not pay for orthopedic shoes unless they are a necessary part of the leg brace and the cost is included in the charge for the brace. Medicare does not pay for dental plates or other dental devices.

You pay 20% of Medicare-approved amounts.

Radiation therapy is covered for patients who are hospital inpatients or outpatients, and in freestanding clinics.

In a freestanding facility, radiation therapy is covered by Part B.

You pay 20% of Medicare-approved amounts.

Medicare will help pay for a second opinion before surgery. A doctor may tell you that you need surgery for a health problem that is not an emergency. This means that the surgery does not have to be done right away. You have time to talk with your doctor and decide what is best for you. Deciding what is best for you could include getting a second opinion from another doctor. A second opinion is when another doctor gives his or her view about your health problem and how it should be treated. Medicare will also help pay for a third opinion if the first and second opinions are different.

You pay 20% of Medicare-approved amounts.

You pay nothing for a second opinion for an Ambulatory Surgical Center procedure done in a hospital outpatient department.

Medicare covers mental health care furnished by a doctor or health care professional who can be paid by Medicare. Ask your doctor, psychologist, social worker, or other health professional if they accept Medicare payment before you get treatment.

Outpatient Mental Health Care: Medicare covers mental health services when furnished on an outpatient basis by either a doctor, clinical psychologist, clinical social worker, clinical nurse specialist or physician assistant in an office setting, clinic, or hospital outpatient department.

Medicare covers substance abuse treatment in an outpatient treatment center that is certified by Medicare.

You usually pay 50% of Medicare-approved amounts.

Medicare covers surgical services for covered surgical procedures.

You pay 20% of Medicare-approved amounts.

Therapeutic Shoes: Medicare covers therapeutic shoes for people with diabetes who have severe diabetic foot disease. The doctor who treats your diabetes must certify your need for therapeutic shoes. The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist. Medicare helps pay for one pair of therapeutic shoes per calendar year and for inserts. Shoe modifications may be substituted for inserts.

The fitting of the shoes or inserts is covered in the Medicare payment for the shoes.

You pay 20% of Medicare-approved amounts.

Medicare covers doctor services related to transplants as listed under the coverage information for Transplants (Facility).

You pay 20% of Medicare-approved payment amount for physician services.

Medicare covers bone marrow and cornea transplants under certain conditions. Bone marrow and cornea transplants are not limited to approved facilities. Transplant coverage includes necessary tests, labs, and exams before surgery for you and the organ donor, follow-up care for you and a live donor, and procurement of organs and tissues.

Call your Medicare Carrier for information about cornea and bone marrow transplants.

Medicare currently provides coverage for flu, pneumonia, and hepatitis vaccinations. Other types of vaccinations and immunizations are typically not covered by Medicare. Flu Shots: Medicare covers one flu shot a year, in the fall or winter. All people with Medicare are covered. Pneumoccal Pneumonia Shot: Medicare covers all people with Medicare for the Pneumococcal Pneumonia Shot (vaccine). One shot may be all you ever need, but you should discuss this with your doctor. Hepatitis B Shot: Medicare covers the Hepatitis B Shot (vaccine) for all people with Medicare who are are at medium to high risk for hepatitis B. You should discuss your risks for hepatitis B with your doctor.

You pay $0 for a flu shot if the doctor or health care provider accepts assignment. You pay $0 for pneumococcal pneumonia shots if your doctor or health care provider accepts assignment. You pay 20% of Medicare-approved amounts for the Hepatitis B vaccine given in a doctor's office. If the Hepatitis B Shot is given in a hospital outpatient department, you pay a set copayment amount. You pay 100% for all other immunizations and vaccinations.

Medicare covers durable medical equipment (DME) that your doctor prescribes for use in your home. Only your own doctor should prescribe medical equipment for you.

Durable Medical Equipment:

Covered Durable Medical Equipment includes, but is not limited to:

Make sure your supplier is enrolled by Medicare and has a Medicare supplier number. Suppliers have to meet strict standards to qualify for a Medicare supplier number. Medicare will not pay your claim if your supplier is not enrolled in Medicare and does not have a Medicare supplier number.

The amount you pay varies. Call your Medical Durable Equipment Carrier for more information. Medicare pays for different kinds of DME in different ways; some equipment must be rented, other equipment must be purchased, and for some equipment you may choose rental or purchase.

If a supplier of Durable Medical Equipment does not accept assignment, there is no limit to what can be charged. You also may have to pay the entire bill (your share and Medicare's share) at the time you get the Durable Medical Equipment. Always ask the supplier if they accept assignment. It could save you money.

Medicare covers durable medical equipment (DME) that your doctor prescribes for use in your home. Only your own doctor should prescribe medical equipment for you.

Durable Medical Equipment:

Covered Durable Medical Equipment includes, but is not limited to:

Make sure your supplier is enrolled by Medicare and has a Medicare supplier number. Suppliers have to meet strict standards to qualify for a Medicare supplier number. Medicare will not pay your claim if your supplier is not enrolled in Medicare and does not have a Medicare supplier number.

The amount you pay varies. Call your Medical Durable Equipment Carrier for more information. Medicare pays for different kinds of DME in different ways; some equipment must be rented, other equipment must be purchased, and for some equipment you may choose rental or purchase.

If a supplier of Durable Medical Equipment does not accept assignment, there is no limit to what can be charged. You also may have to pay the entire bill (your share and Medicare's share) at the time you get the Durable Medical Equipment. Always ask the supplier if they accept assignment. It could save you money.

Medicare covers diagnostic tests like CT Scans, MRIs, EKGs, and X-rays. Diagnostic tests are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare does not cover most routine screening tests.

Some preventive tests and screenings are covered by Medicare (for example, mammograms).

If the diagnostic tests or x-rays is performed at your physician's office or at a freestanding (independent) outpatient diagnostic testing facility: You pay 20% of Medicare-approved amounts for covered diagnostic tests and x-rays.

If the diagnostic tests or x-rays are performed at a hospital outpatient setting: You pay a set copayment amount for covered diagnostic tests and x-rays under the Outpatient Prospective Payment System (OPPS). The amount you pay depends on the diagnostic test you receive. Please contact the Medicare Carrier listed below for specific copayment amounts in your area.

Alternative therapies (including Acupuncture, Chelation Therapy, Biofeedback and Holistic Medicine) are not covered by Medicare.

You pay 100%.

Cosmetic surgery is generally not covered unless it is needed because of accidental injury or to improve the function of a malformed part of the body.

Generally, you pay 100% for cosmetic surgery.

Medicare does not cover custodial care when that is the only kind of care you need. Care is considered custodial when it is for the purpose of helping you with activities of daily living or meeting personal needs and could be done safely and reasonably by people without professional skills or training. For example, custodial care includes help getting in and out of bed, bathing, using the bathroom, dressing, eating, and taking medicine.

Medicare does cover limited skilled nursing facility care under certain conditions. For more information, see the coverage information listed under Skilled Nursing Facility Care.

In general, you pay 100%.

Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. Medicare does not pay for dental plates or other dental devices. Medicare Part A will pay for certain dental services that you get when you are in the hospital.

Medicare Part A can pay for hospital stays if you need to have emergency or complicated dental procedures, even when the dental care itself is not covered. In these cases you should call your Fiscal Intermediary for more information.

In general, you pay 100% for dental services.

Insulin, syringes, and needles are not covered.

If you use an insulin pump, insulin and the pump could be covered as durable medical equipment. There may be some limits on covered supplies or how often you get them. For more information, please refer to the coverage information listed under Durable Medical Equipment.

You pay 100% for insulin (unless used in a pump), syringes, and needles.

Medicare does not cover routine eye exams.

You pay 100% for routine eye exams.You pay 20% of Medicare-approved amounts for diagnosis and treatment of diseases and conditions of the eye.

Generally, Medicare does not cover eyeglasses or contact lenses.

You pay 100%.

Medicare generally does not cover health and wellness education.

Generally, you pay 100%.

Most nursing home care is custodial care. Generally, Medicare does not cover custodial care. Medicare Part A only covers skilled care given in a certified skilled nursing facility (SNF). You must meet certain conditions and coverage is limited. Please refer to the coverage information for Skilled Nursing Facility Care.

You pay 100%.

Routine physical exams are not covered by Medicare.

You pay 100% for routine physical exams.

Common medical supplies like bandages and gauze are generally not covered by Medicare.

Medicare covers some diabetic and dialysis supplies. Please refer to the coverage information listed under Diabetic Supplies and Dialysis (Kidney) Home Dialysis Equipment and Supplies.

You pay 100% for most common medical supplies.

Medicare generally does not cover transportation to get routine health care.

For information about ambulance transportation, please refer to the information listed under Ambulance Services.

You pay 100% for transportation to get routine health care.