ORIGINAL MEDICARE PART A & PART B

What does it mean and what does it cover?

Medicare Services

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Part A

Helps cover:

Inpatient Care in Hospitals.

Medicare covers semi-private rooms, meals, general nursing, drugs (Including methadone to treat an opioid use disorder), and other hospital services and supplies as part of your inpatient treatment. This includes care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, psychiatric care in inpatient psychiatric facilities, and inpatient care for a qualifying clinical research study. This doesn’t include private-duty nursing, a television or phone in your room (if there’s a separate charge for these items), personal care items (razors or slipper socks), or a private room, unless medically necessary. There are day limits of what is covered

Skilled Nursing Facility Care (Not Custodial or Long Term)

Medicare covers semi-private rooms, meals, skilled nursing and therapy services, and other medically necessary services and supplies in a skilled nursing facility. Medicare only covers these services after a 3-day minimum (not including the day you leave the hospital), medically necessary, inpatient hospital stay for a related illness or injury.
To qualify for skilled nursing facility care, your doctor must certify that you need daily skilled care (like intravenous fluids/medications or physical therapy) which, as a practical matter, you can only get as a skilled nursing facility inpatient.

Inpatient Care in religious non-medical healthcare institution

If you qualify for inpatient hospital or skilled nursing facility care in these facilities, Medicare will only cover inpatient, non-religious, non-medical items and services like room and board, and items or services that don’t need a doctor’s order or prescription (like unmedicated wound dressings or use of a simple walker). Medicare doesn’t cover the religious portion of this type of care.

Hospice Care

To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, you’re agreeing to comfort care (palliative care) instead of care to cure your terminal illness. You also must sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions. Coverage includes:

All items and services needed for pain relief and symptom management
Medical, nursing, and social services
Drugs for pain management
Durable medical equipment for pain relief and symptom management
Aide and homemaker services
Other covered services you need to manage your pain and other

symptoms, as well as spiritual and grief counseling for you and your family.

Home Health Care

Medicare covers home health services if you need part-time or intermittent skilled services and if you’re “homebound,” which means:

You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
Leaving your home isn’t recommended because of your condition.
You’re normally unable to leave your home because it’s a major effort.

Part B

Helps cover:

Medicare Part B (Medical Insurance) helps cover medically necessary doctor’s services, outpatient care, home health services, durable medical equipment, mental health services, and other medical services. Part B also covers many preventive services.

Services from doctors and other health care providers

Medically necessary doctor services (including outpatient services and some inpatient hospital doctor services, emergency, e-visit and covered preventive services.

Outpatient care

Many diagnostic and treatment services you get as an outpatient from a Medicare-participating hospital are covered.

Home health care

Medicare covers home health services if you need part-time or intermittent skilled services and if you’re “homebound,” which means: You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, leaving your home isn’t recommended because of your condition or you’re normally unable to leave your home because it’s a major effort.

Durable medical equipment

You must use specific suppliers called “contract suppliers” for wheelchairs, walkers, hospital beds and other equipment like defibrillators, diabetes equipment supplies and therapeutic shoes or Medicare won’t pay for them.

Many preventive services

Like screenings, shots, or vaccines, and yearly “Wellness” visits as well as abdominal aortic aneurysm screening, acupuncture, alcohol misuse screening, ambulance services to the nearest appropriate medical facility, ambulatory surgical center facility where surgical procedures are performed, and the patient is expected to be released within 24 hours, some bariatric surgical procedures, may pay behavioral health condition like depression, anxiety, or another mental health condition, bone mass measurements, cardiac rehab and screenings, cervical cancer screenings & chemotherapy, manipulation of the spine by a chiropractor if medically necessary to correct a subluxation, chronic care management services, cognitive assessment and care services, colorectal cancer screenings, CPAP devices, tobacco use counseling, depression screening, diabetes screening, flu shots, hepatitis B & C screenings/shots, glaucoma tests and to see the full list of covered services, visit medicare.gov.

Drugs

A limited number of outpatient prescription drugs like injections you get in a doctor’s office, certain oral anti-cancer drugs, drugs used with some types of durable medical equipment (like a nebulizer or external infusion pump), immunosuppressant drugs (see page 51), and, under very limited circumstances, certain drugs you get in a hospital outpatient setting.