- Abdominal
Aortic Aneurysm
Screening (Preventive
Service): A one-time screening
ultrasound for people
at risk (like people
who have smoked).
Medicare only covers
this screening if
you get a referral
for it as a result
of your "Welcome
to Medicare" physical exam. You pay coinsurance.
- Ambulance
Services: When you
need to be transported
to a hospital or
a skilled nursing
facility for medically
necessary services,
and transportation
in any other vehicle
would endanger your
health. You pay coinsurance,
and Part B deductible
applies.
- Ambulatory
Surgery Center Fees: Facility fees for
approved services
at an Ambulatory
Surgery Center (facility
where surgical procedures
are performed, and
the patient is released
the same day). You
pay coinsurance,
and Part B deductible
applies.
- Blood: Pints
of blood you get,
starting with the
4th, as an outpatient
or as part of a Part
B-covered service.
The first three pints
aren't covered. You
pay coinsurance,
and Part B deductible
applies.
- Bone
Mass Measurement
(Preventive Service): To help
see if you are at
risk for broken bones.
This service is covered
once every 24 months
(more often if medically
neccessary) for people
who have certain
medical conditions
or meet certain criteria.
You pay coinsurance,
and Part B deductible
applies.
- Cardiovascular
Screenings (Preventive
Service): To help
prevent a heart attack
or stroke. This service
is covered every
5 years to test your
cholesterol, lipid,
and triglyceride
levels. No cost.
- Chiropractic
Services (Limited): To correct
a subluxation (when
one or more of the
bones of your spine
move out of position)
using manipulation
of the spine. You
pay coinsurance,
and Part B deductible
applies.
- Clinical
Laboratory Services: Including certain
blood tests, urinalysis,
some screening tests,
and more. No cost.
- Clinical
Research Studies: To help
doctors and researchers
find better ways
to prevent, diagnose,
or treat diseases.
Clinical research
studies test new
types of medical
care, like how well
a new cancer drug
works. Usual patient
care costs are covered
if you take part
in a qualifying clinical
research study. If
the item or services
isn't covered outside
of a clinical research
study, the cost of
the investigational
item or service may
nor be covered. You
pay coinsurance,
and Part B deductible
applies.
- Colorectal
Cancer Screenings
(Preventative Service): To help find precancerous
growths and help
prevent or find cancer
early, when treatment
is most effective.
One or more tests
may be covered...talk
to your doctor.
- Diabetes
Screenings (Preventive
Service): To check
for diabetes. These
screenings are covered
if you have any of
the following risk
factors: high blood
pressure (hypertension),
dyslipidemia (history
of abnormal cholesterol
and triglyceride
levels), obesity,
or a history of high
blood sugar. Tests
are also covered
if you answer yes
to two or more of
the following questions: • Are you age 65 or older? • Are
you overweight? • Do you have a family history of
diabetes (parents, siblings)? • Do you have a history
of gestational diabetes (diabetes during pregnancy) or
did you deliver a baby weighing more than nine pounds?
Based on the results of these tests, you may be eligible
for up to two diabetes screenings every year. No cost.
- Diabetes
Self-Management
Training (Preventive): For people with diabetes.
Your doctor or other
health care people
must provide a written
order. You pay coinsurance,
and Part B deductible
applies.
- Diabetes
Supplies: Including
glucose testing monitors,
blood glucose test
strips, lancet devices
and lancets, glucose
control solutions,
and therapeutic shoes
(in some cases).
Syringes and insulin
are only covered
if used with an insulin
pump, but may be
covered by Medicare
prescription drug
coverage (Part D).
You pay coinsurance,
and Part B deductible
applies.
- Doctor
Services: Services that are
medically necessary
or covered preventive
services. Doesn't
cover routine physical
except for the one-time "Welcome
the Medicare" physical exam. You pay coinsurance,
and Part B deductible applies.
- Durable
Medical Equipment: Items
such as oxygen, wheelchairs,
walkers, and hospital
beds needed for use
in the home. For
certain equipment,
such as wheelchairs
and hospital beds,
Medicare pays rental
fees for up to 13
months (36 months
for oxygen). After
this, you own the
equipment, and Medicare
pays for maintenance.
For Medicare to cover
your equipment, you
must go to a supplier
that is enrolled
in Medicare. You
pay coinsurance,
and Part B deductible
applies. In some
cases, if you buy
the equipment without
renting it first,
Medicare pays no
part. New: In 2008,
you may have to use
certain Medicare-contract
suppliers to get
certain durable medical
equipment in some
geographic areas.
Call 1-800-633-4227
for more information.
TTY users should
call 1-877-486-2048.
- Emergency
Room Services: 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
coinsurance, and
Part B deductible
applies.
- Eye
Exams: For people with diabetes
to check for diabetic
retinopathy once
every 12 months.
You pay coinsurance,
and Part B deductible
applies.
- Eyeglasses
(Limited): One pair
of eyeglasses with
standard frames (or
one set of contact
lenses) after cataract
surgery that implants
an intraocular lens.
You pay coinsurance,
and Part B deductible
applies.
- Flu
Shots (Preventive
service): To help prevent influenza
or flue virus. This
is covered once a
flu season in the
fall or winter. The
flu is a serious
illness. You need
a flu shot for the
current virus each
year. No cost.
- Foot
Exams and Treatment: If you have diabetes-related
nerve damage and/or
meet certain conditions.
You pay coinsurance,
and Part B deductible
applies.
- Glaucoma
Tests (Preventive
service): To help
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, a
family history of
glaucoma, 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 coinsurance,
and Part B deductible
applies.
- Hearing
and Balance Exams: 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
coinsurance, and
Part B deductible
applies.
- Hepatitis
B Shots (Preventive
service): To help
protect people from
getting Hepatitis
B. This is covered
(three shots) for
people at high or
medium risk for Hepatitis
B. Your risk for
Hepatitis B increases
if you have hemophilia,
End-Stage Renal Disease
(permannt kidney
failure requiring
dialysis or a kidney
transplant), or a
condition that lowers
your resistance to
infection. Other
factors may increase
your risk for Hepatitis
B, so check with
your doctor to see
if you are at high
or medium risk. You
pay coinsurance,
and Part B deductible
applies.
- Home Health
Services: Limited
to reasonable and
necessary part-time
or intermittent skilled
care or continuing
need for physical
therapy, occupational
therapy, or speech-related
pathology ordered
by a doctor and provided
by a Medicare-certified
home health agency.
Home health services
may also include
medical social services,
home health aide
services or other
services, durable
medical equipment
(such as wheelchairs,
hospital beds, oxygen,
and walkers) and
medical supplies
for use at home.
No cost for home
healh services. You
pay coinsurance,
and Part B deductible
applies for dirable
medical equipment.
- Kidney Dialysis Services
and Supplies: Either
in a facility or
at home when your
doctor orders it.
You pay coinsurance,
and Part B deductible
applies.
- Mammograms
(screening) (Preventive
service): A type
of x-ray to check
women for breast
cancer before they
or their doctor may
be able to feel 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 coinsurance.
- Medical Nutrition Therapy Services
(Preventive service): Medicare may cover
medical nutrition therapy if you have diabetes or kidney
disease and your doctor refers you for the service. You
pay coinsurance, and Part B deductible applies.
- Mental Health care (outpatient): To get help with
mental health issues
such as depression or anxiety. Includes services generally
given outside a hospital or in a hospital outpatient department,
including visits with a doctor, clinical psychologist or
clinical social worker, and lab tests. Certain limits and
conditions apply. You pay coinsurance, and Part B deductible
applies. Note: Talk to your doctor if you feel sad, have
little interest in things you used to enjoy, or have thoughts
about ending your life.
- Occupational Therapy: Services to
help you return to
usual activities (such as bathing) after an illness when
your doctor orders them. You pay coinsurance, and Part B
deductible applies.
- Outpatient Hospital Services: Services
you get as an outpatient
as part of a doctor's care. You pay coinsurance, and Part
B deductible applies.
- Outpatient
Medical and Surgical
Services and Supplies: For approved procedures. You pay
coinsurance, and Part B deductible applies. Pap Test and
Pelvic Exam (includes clinical breast exam) (Preventive
service): To check for cervical and vaginal cancers. Medicare
covers these screening tests once every 24 months for women
at low risk, and
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 three years. No
cost for the Pap lab test. You pay coinsurance for Pap test
collection, and pelvic and breast exams.
- Physical Exam (One-time "Welcome to Medicare" Physical
Exam) (Preventive
service): A one-time review of your health,
and education and counseling about preventive services,
including certain screenings and shots and referrals for
other care if needed. Important: You must have the physical
exam within the first 6 months you have Part B for it to
be covered by Medicare. You pay coinsurance, and Part B
deductible applies.
- Physical Therapy: Evaluation and treatment
of injuries and disease
using various procedures, such as exercises and testing,
when your doctor orders it. It may also include heat, light,
and ultrasound therapy. You pay coinsurance, and Part B
deductible applies.
- Pneumococcal Shot (Preventive service): To help prevent pneumococcal
infections (like certain types of pneumonia). Most people
only need this preventive service once in their lifetime.
Talk with your doctor. No cost.
- Practitioner Services: Such
as services provided
by clinical social workers, physician assistants, and nurse
practitioners. You pay coinsurance, and Part B deductible
applies.
- Prescription Drugs (limited): Includes certain
injectable cancer
drugs or immunosuppressive drugs. You pay coinsurance, and
Part B deductible applies. Note: See Part D for additional
Medicare prescription drug coverage.
- Prostate Cancer Screening
(Preventive service): These tests help detect prostate cancer. Medicare covers
a digital rectal exam (You pay coinsurance, and Part B deductible
applies for the exam) and Prostate Specific Antigen (PSA)
test once every 12 months for all men with Medicare over
age 50. No cost for the PSA test.
- Prosthetic/Orthotic Items: Including arm, leg,
back, and neck braces; artificial eyes; artificial limbs
(and their replacement parts); breast prostheses (after
mastectomy); prosthetic devices needed to replace an internal
body part or function (including ostomy supplies, and prenteral
and enteral nutrition therapy). For Medicare to cover your
prosthetic or orthotic, you must go to a supplier that is
enrolled in Medicare. You pay coinsurance, and Part B deductible
applies.
- Rural Health Clinic and Federally-Qualified
Health Center Services: A broad range of
primary care services
usually provided
on an outpatient basis. You pay coinsurance, and Part B
deductible applies for rural health clinic services.
- Second Surgical Opinions: Covered in some cases for surgery
that isn't an emergency.
in some cases, Medicare
covers third surgical
opinions. You pay
coinsurance, and
Part B deductible
applies.
- Smoking
Cessation (counseling
to stop smoking)
(Preventive service): Covered if your doctor
orders it. Includes counseling for 2 cessation attempts
within a 12 month period if you are diagnosed with a smoking-related
illness or are taking medicine that may
be affected by tobacco.
Counseling for each
cessation attempt
includes up to four
face-to-face visits. You pay coinsurance,
and Part B deductible
applies.
- Speech-Language Pathology Services: Treatment given
to regain and strengthen
speech skills when your doctor orders it. You pay coinsurance,
and Part B deductible applies.
- Surgical Dressings: For treatment
of a surgical or
surgically-treated wound. You pay coinsurance,
and Part B deductible
applies.
- Telemedicine: In some rural areas,
under certain conditions
and only in a provider's
office, a hospital, or a federally-qualified health center.
You pay coinsurance, and Part B deductible applies.
- Tests: Including X-Rays, MRIs, CT scans, EKGs,
and some other diagnostic
tests. You pay coinsurance, and Part B deductible applies.
- Transplants: Including doctor services for heart, lung,
kindey, pancreas,
intestine, and liver transplants under certain conditions
and only in a Medicare-certified facility. Bone marrow
and cornea transplants
are covered (under certain conditons. Immunosuppressive
drugs are covered if Medicare paid for the transplant, or
and employer or union group health plan that was required
to pay before Medicare paid for it. You must have been entitled
to Part A at the time of the transplant and Part B at the
time you get immunosuppressive drugs, and the transplant
must
have been performed in a Medicare-certified facility. If
you join a Medicare Advantage Plan, check with the plan
for information on transplant coverage. You pay coinsurance,
and Part B deductible applies. Note: Medicare drug plans
may cover immunosuppressive drugs, even if Medicare or
an employer or union group health plan didn't pay for the
transplant.
- Travel (health care needed when traveling
outside the United States): Limited to medical services provided in Canada when you
travel on the most direct route through Canada between Alaska
and another state. Medicare also covers hospital, ambulance,
and doctor services if you are in the U.S., but the nearest
hospital that can treat you isn't in 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). In some limired
cases, Medicare may
pay for services
you get while on
board a ship within
the territorial waters
adjoining the land
areas of the U.S.
You pay coinsurance,
and Part B deductible
applies.
- Urgently
Needed Care: To treat
a sudden illness
or injury that isn't
a medical emergency.
You pay coinsurance,
and Part B deductible
applies.
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