Medicare Coverage

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medicare cardIn general, Medicare coverage includes services such as surgeries, lab tests, and physician services. In addition, it also covers supplies like wheelchairs and walkers that are considered medically necessary to treat a condition or disease.

If you purchase a Medicare Advantage Plan or other Medicare Plan, you might have different rules, but the plan must provide at least the same coverage as Original Medicare.

Medicare Part A (Hospital Benefit)

  • Hospital Care – coverage includes semi private room, general nursing, meals, and other services and supplies. Includes care in critical access hospital, acute care hospital, inpatient rehabilitation hospital, and long term hospitals.
  • Skilled Nursing Facility Care – coverage includes semi private room, meals, skilled nursing care, physical & occupational therapy, speech-language pathology services, medical social services, medications, supplies & equipment, ambulence transportation, and dietary counseling.
  • Hospice – doctor & hospice team will work with you and your family to set up a plan of care that meets your needs
    Home health services – coverage includes intermittent skilled nursing care, physical therapy, speech-language pathology, and more.

Medicare Part B (Medical Benefit)

  • Clinical research – necessary to test different types of medical care. Coverage may include treatment of side effects and complications that may result from the study, an operation to implant an item that is being tested, or room & board for a hospital stay that Medicare would pay for even if you were not in a covered research study.
  • Ambulance services – covers emergency ambulance transportation when you need medical services at a hospital or skilled nursing facility. Medicare will only pay for air transportation if you require immediate transportation and you can not easily get ground transportation.
  • Durable medical equipment – Coverage includes equipment that your doctor prescribes for in home care.
  • Mental health – coverage includes inpatient, outpatient, and partial hospitalization
  • Second opinion before surgery – covers a second opinion that will help you make an informed decision.
  • Limited outpatient prescription drugs – coverage includes infused drugs, some antigens, osteoporosis drugs, erythropoisis-stimulating agents, and injections.

Medicare Part C (Medicare Advantage)

  • Health Maintenance Organization (HMO) Plans
  • Preferred Provider Organization (PPO) Plans
  • Private Fee-for-Service (PFFS) Plans
  • Special Needs Plans (SNPs)

Medicare Part D (Prescription Drug Plans)

  • Every Medicare Prescription Drug Plan has its own formulary (list of covered drugs).