Medicare Part A & B: What They Cover
Medicare Part A helps you pay for the following:
- Inpatient hospital care for up to 90 days each benefit period, plus 60 lifetime reserve days in a general hospital. It also covers up to 190 lifetime days in a Medicare-certified specialty psychiatric hospital.
Medicare Part A covers:
- A semi-private room
- General nursing
- Other hospital services and supplies
- Skilled nursing facility (SNF) care for up to 100 days each benefit period. To qualify, you must have been in the hospital for at least three consecutive days in the 30 days before admission and need skilled nursing services seven days a week, or physical, occupational or speech therapy services five days a week.
- Home health care for up to 100 days. To qualify, you must have been in the hospital for at least three days in the 14 days before receiving care and be homebound. Note: You can get coverage for home health care without a hospital stay through Medicare Part B.
- Hospice Care for as long as your doctor certifies you need care. To qualify, a doctor must
Medicare Part B covers 2 types of services:
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice; such as:
- Emergency room treatment
- All physician charges and all outpatient charges, including x-rays lab tests. Part B covers any charge that is not considered hospitalization. You become eligible for Part B on your 65th birth month, but can defer Part B if you are working and have creditable coverage, and can later enroll in Part B when you have retired. You will not pay any penalty as long as your prior coverage was credible.
- Durable medical equipment (DME) if your doctor certifies you need it and you buy or rent it from a Medicare-certified supplier.
- Ambulance services if your health requires ambulance transport and you are traveling to or from certain locations.
- Coverage of non-emergency ambulance services
- Air transportation
- Outpatient physical, speech, and occupational therapy services
- Chiropractic care when manipulation of the spine is medically necessary to fix a subluxation of the spine. A subluxation is when one or more of the bones of the spine move out of position.
- Outpatient mental health services
- Skilled nursing services and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases).
- Medical social services. Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This might include counseling or help finding resources in your community.
- Medical supplies. Medicare pays in full for certain medical supplies provided by the Medicare-certified home health agency, such as wound dressings and catheters needed for your care.
- Clinical research studies
- Urgent care centers
- Diagnostic radiology services
- Therapeutic radiology services
- Diagnostic tests and procedure clinics
- Out-patient x-ray clinics
- Podiatrist services
- Low vision rehabilitation
- Clinical research
- Parenteral and enteral nutrition
- Part B: out-patient injectable medication
- Immunosuppressive drugs & vitamins
- Oral cancer drugs
- Oral anti-nausea drugs
- Self-administered drugs in hospital outpatient settings
- Immunizations & vaccinations
- Cardiac rehab
- Diabetes supplies
- Prosthetic and orthotics
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment. As long as you meet basic eligibility standards, you have the right to receive these services no matter if you have Original Medicare or a Medicare Advantage Plan (Medicare private health plan). It includes an Annual Preventive Screening for Depression.
What Part Medicare Part A & Part B doesn't cover
Medicare doesn't cover everything. If you need certain services Medicare doesn't cover, you'll have to pay for them yourself unless you have other insurance or you're in a Medicare health plan that covers them. Some of the items and services that Medicare doesn't cover include:
- Long-term care (also called custodial care)
- Most dental care
- Eye examinations related to prescribing glasses
- Cosmetic surgery
- Hearing aids and exams for fitting them
- Routine foot care
- Private duty nursing
- A television or telephone in your room
- A private room (unless medically necessary or if it is the only room available)