Medicare Part A Covers:

If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 pints of blood you get in a calendar year or have the blood donated. In most cases, the hospital gets blood from a blood bank at no charge, and you won’t have to pay for it or replace it.

Limited to medically-necessary part-time or intermittent skilled nursing care or physical therapy, speech-language pathology, or a continuing need for occupational therapy. Care must be ordered by a doctor and provided by a Medicare-certified home health agency. Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment (see page 30), and medical supplies for use at home. You must be homebound, which means that leaving home takes a lot of effort. Part A covers the cost of the first 100 home health visits following a hospital stay.

For people with a terminal illness who are expected to live 6 months or less (as certified by a doctor). Coverage may include drugs (for pain relief and symptom management), medical, nursing, social services, and other covered services as well as services not usually covered by Medicare (like grief counseling). Hospice care is usually given in your home (or other facility like a nursing home) by a Medicare-approved hospice. Medicare covers some short-term inpatient stays (for pain and symptom management that requires an inpatient stay) in a Medicare approved facility, such as a hospice facility, hospital, or skilled nursing facility. Medicare also covers inpatient respite care (care given to a hospice patient so that the usual caregiver can rest). You can stay in a Medicare-approved facility up to 5 days each time you get respite care. Medicare may pay for covered services for health problems that aren’t related to your terminal illness. You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you are terminally ill.

Includes semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. Examples include inpatient care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study and mental health care. This doesn’t include private-duty nursing, a television or telephone in your room, or personal care items like razors or slipper socks. It also doesn’t include a private room, unless medically necessary. The doctor services you get while you are in a hospital are covered under Part B.

Includes semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies (only after a 3-day minimum inpatient hospital stay for a related illness or injury) for up to 100 days in a benefit period. To get care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare doesn’t cover long-term care or custodial care in this setting.

Medicare Part B Covers (wellness is highlighted for your convenience):

A one-time screening ultrasound for people at risk. Medicare only covers this screening if you get a referral for it as a result of your one-time "Welcome to Medicare" physical exam. You pay 20% of the Medicare-approved amount.

Emergency ground transportation when you need to be transported to a hospital or skilled nursing facility for medically-necessary services, and transportation in any other vehicle could endanger your health. Medicare will pay for transportation in an airplane or helicopter if you require immediate and rapid ambulance transportation that ground transportation can’t provide. In some cases, Medicare may pay for limited non-emergency transportation if you have orders from your doctor. Medicare will only cover services to the nearest appropriate medical facility that is able to give you the care you need. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Facility fees for approved surgical procedures provided in an ambulatory surgical center (facility where surgical procedures are performed, and the patient is released the same day). You pay 20% of the Medicare-approved amount (except for flexible sigmoidoscopies and screening colonoscopies, for which you pay 25%), and the Part B deductible applies. You pay all facility charges for procedures Medicare doesn’t allow in ambulatory surgical centers.

If the provider has to buy blood for you, you must either pay the provider costs for the first 3 pints of blood you get in a calendar year or have the blood donated. In most cases, the provider gets blood from a blood bank at no charge, and you won’t have to pay for it or replace it. You pay 20% of the Medicare-approved amount for additional pints of blood you get as an outpatient, and the Part B deductible applies.

Helps to see if you are at risk for broken bones. This service is covered once every 24 months (more often if medically necessary) for people who have certain medical conditions or meet certain criteria. You pay 20% of the Medicare approved amount, and the Part B deductible applies.

Screenings Helps prevent a heart attack or stroke. This service is covered every 5 years to test your cholesterol, lipid, and triglyceride levels. No cost for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.

Helps correct a subluxation (when one or more of the bones of your spine move out of position) using manipulation of the spine. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Including certain blood tests, urinalysis, some screening tests, and more. No cost to you.

Clinical research studies test different types of medical care, like how well a cancer drug works. Medicare covers some costs, like doctor visits and tests, in qualifying clinical research studies. Clinical research studies help doctors and researchers see if the new care works and if it’s safe. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Note: If you get a flexible sigmoidoscopy or screening colonoscopy in an outpatient hospital setting or an ambulatory surgical center, you pay 25% of the Medicare-approved amount.

For some people diagnosed with heart failure. You pay 20% of the Medicare-approved amount, but no more than the Part A hospital stay deductible if you get the device as a hospital outpatient. The Part B deductible applies.

Based on the results of these tests, you may be eligible for up to two diabetes screenings every year. No cost for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.

For people with diabetes. Your doctor or other health care provider must provide a written training order. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Note: Insulin and certain medical supplies used to inject insulin, such as syringes, may be covered by Medicare prescription drug coverage (Part D).

Services that are medically necessary (includes outpatient and some doctor services you get when you are a hospital inpatient) or covered preventive services. Doesn’t cover routine physicals except for the one-time "Welcome to Medicare" physical exam. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Items such as oxygen equipment and supplies, wheelchairs, walkers, and hospital beds ordered by your doctor for use in the home. Some items must first be rented. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. You must get your covered equipment or supplies from a supplier enrolled in Medicare. For more information, visit www.medicare.gov/Publications/Pubs/pdf/11045.pdf to view "Medicare Coverage of Durable Medical Equipment and Other Devices."

When you believe your health is in serious danger. You may have a bad injury, a sudden illness, or an illness that quickly gets much worse. You pay a specified copayment for the hospital emergency department visit, and you pay 20% of the Medicare-approved amount for the doctor’s services. The Part B deductible applies.

For people with diabetes to check for diabetic retinopathy once every 12 months. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

One pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Provides a broad range of outpatient primary care and preventive services. You pay 20% of the Medicare-approved amount.

Helps prevent influenza or flu virus. This is covered once a flu season in the fall or winter. You need a flu shot for the current virus each year. No cost to you for the flu shot if the doctor accepts assignment for giving the shot.

If you have diabetes-related nerve damage and/or meet certain conditions. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Helps find the eye disease glaucoma. This is covered once every 12 months for people at high risk for glaucoma. You are considered high risk for glaucoma if you have diabetes, or a family history of glaucoma, or are African-American and age 50 or older, or are Hispanic and age 65 or older. Tests must be done by an eye doctor who is legally authorized by the state. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

If your doctor orders it to see if you need medical treatment. Hearing aids and exams for fitting hearing aids aren’t covered. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Helps protect people from getting Hepatitis B. This is covered for people at high or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (ESRD), or a condition that lowers your resistance to infection. Other factors may increase your risk for Hepatitis B, so check with your doctor about your risk. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Limited to medically-necessary part-time or intermittent skilled nursing care or physical therapy, or speech-language pathology, or a continuing need for occupational therapy. Must be ordered by a doctor and provided by a Medicare-certified home health agency. Home health services may also include medical social services, part-time or intermittent home health aide services, durable medical equipment and medical supplies for use at home. You must be homebound, which means that leaving home takes a lot of effort. No cost to you for home health services. For Medicare-covered durable medical equipment, you pay 20% of the Medicare-approved amount, and the Part B deductible applies.

For people with ESRD. Dialysis is covered either in a facility or at home when your doctor orders it. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

A type of X-ray to check women for breast cancer before they or their doctor may be able to find it. Screening mammograms are covered once every 12 months for all women with Medicare age 40 and older. Medicare covers one baseline mammogram for women between age 35 and 39. You pay 20% of the Medicare-approved amount.

Medicare may cover medical nutrition therapy and certainrelated services if you have diabetes or kidney disease, and your doctor refers you for the service. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

To get help with mental health conditions such as depression, anxiety, or substance abuse. Includes services generally given outside a hospital or in a hospital outpatient department, including visits with a doctor, psychiatrist, clinical psychologist, or clinical social worker, and lab tests. Certain limits and conditions apply. For doctor or other health care provider visits to diagnose, or to monitor or change your prescription, you pay 20% of the Medicare-approved amount. For outpatient treatment of your mental health condition (such as therapy), you pay 50% of the Medicare-approved amount. The Part B deductible applies.

Talk to your doctor if you feel sad, have little interest in things you used to enjoy, feel dependent on drugs or alcohol, or have thoughts about ending your life.

Evaluation and treatment to help you return to usual activities (such as dressing or bathing) after an illness or accident when your doctor certifies you need it. In 2009, there may be limits on physical therapy, occupational therapy, and speech-language pathology services and exceptions to these limits. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Services you get as an outpatient as part of a doctor’s care. You pay a specified copayment for each service. The copayment can’t be more than the Part A hospital stay deductible. The Part B deductible applies.

Checks for cervical, vaginal, and breast cancers. Medicare covers these screening tests once every 24 months, or once every 12 months for women at high risk, and for women of child-bearing age who have had an exam that indicated cancer or other abnormalities in the past 3 years. No cost to you for the Pap lab test. You pay 20% of the Medicare-approved amount for Pap test collection, and pelvic and breast exams.

A one-time review of your health, and education and counseling about preventive services, including certain screenings, shots, and referrals for other care if needed.

New: Starting January 1, 2009, Medicare will cover this exam ifyou get it within the first 12 months you have Part B. You pay 20% of the Medicare-approved amount, and the Part B deductible no longer applies.

Important: In 2008, you had to get the physical exam within the first 6 months you had Part B, and the Part B deductible applied.

Evaluation and treatment for injuries and diseases that change your ability to function when your doctor certifies your need for it. In 2009, there may be limits on these services and exceptions to these limits. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Helps prevent pneumococcal infections (like certain types of pneumonia). Most people only need this preventive shot once in their lifetime. Talk with your doctor. No cost if the doctor or supplier accepts assignment for giving the shot.

Such as services provided by physician assistants and nurse practitioners. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Includes a limited number of prescription drugs such as those you get in a hospital outpatient department under certain circumstances, injected drugs you get in a doctor’s office, certain oral cancer drugs, and drugs used with some types of durable medical equipment (like a nebulizer or infusion pump). You pay 20% of the Medicare-approved amount, and the Part B deductible applies. Note: Other than the examples above, under Part B, you pay 100% for most prescription drugs, unless you have Part D or other drug coverage.

Helps detect prostate cancer. Medicare covers a digital rectal exam and Prostate Specific Antigen (PSA) test once every 12 months for all men with Medicare over age 50. You pay 20% of the Medicare-approved amount, and the Part B deductible applies for the doctor’s visit. No cost to you for the PSA test.

Including arm, leg, back, and neck braces; artificial eyes; artificial limbs (and their replacement parts); breast prostheses (after mastectomy); and prosthetic devices needed to replace an internal body part or function (including ostomy supplies, and parenteral and enteral nutrition therapy) when ordered by a doctor. For Medicare to cover your prosthetic or orthotic, you must go to a supplier that is enrolled in Medicare. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Provides a broad range of outpatient primary care services. You pay 20% of the amount charged, and the Part B deductible applies.

Covered in some cases for surgery that isn’t an emergency. In some cases, Medicare covers third surgical opinions. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Includes up to 8 face-to-face visits in a 12-month period if you are diagnosed with an illness caused or complicated by tobacco use, or you take a medicine that is affected by tobacco. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Evaluation and treatment given to regain and strengthen speech and language skills including cognitive and swallowing skills when your doctor certifies your need for it. In 2009, there may be limits on these services and exceptions to these limits. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

For treatment of a surgical or surgically-treated wound. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Medical or other health services given to a patient using a communications system (like a computer, telephone, or television) by a provider in a location different from the patient’s. Available in some rural areas, under certain conditions and only in a provider’s office, a hospital, or a federally-qualified health center. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Including X-rays, MRIs, CT scans, EKGs, and some other diagnostic tests. You pay 20% of the Medicare-approved amount, and the Part B deductible applies. If you get the test as a hospital outpatient, you pay a specified copayment that may be more than 20% of the Medicare-approved amount but can’t be more than the Part A hospital stay deductible.

Including doctor services for heart, lung, kidney, pancreas, intestine, and liver transplants under certain conditions and only in a Medicare-certified facility. Bone marrow and cornea transplants are covered under certain conditions.

Immunosuppressive drugs are covered if Medicare paid for the transplant, or an employer or union group health plan that was required to pay before Medicare paid for the transplant. You must have been entitled to Part A at the time of the transplant and entitled to Part B at the time you get immunosuppressive drugs, and the transplant must have been performed in a Medicare-certified facility. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Note: Medicare drug plans (Part D) may cover immunosuppressive drugs, even if Medicare or an employer or union group health plan didn’t pay for the transplant.

Medicare generally doesn’t cover health care while you are traveling outside the U.S. (the "U.S." includes the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). There are some exceptions including some cases where Medicare may pay for services that you get while on board a ship within the territorial waters adjoining the land areas of the U.S. In rare cases, Medicare may pay for inpatient hospital, doctor, or ambulance services you get in a foreign country in the following situations:

1) If an emergency arose within the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition

2) If you are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency

3) If you live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

To treat a sudden illness or injury that isn’t a medical emergency. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.