What Does Medicare Cover?

WebMD Medical Reference

This is a general guide to what Medicare covers. To find out about specific things that Medicare covers, visit the Publications page at www.medicare.gov. Download "Your Medicare Benefits." You can also get a printed booklet by calling (800) MEDICARE (800-633-4227).

Medicare Part A

Most people don't have to pay a fee or premium for Medicare Part A. This is because they or a spouse paid Medicare taxes when they were working. To get Part A free, you or a spouse must have worked for at least 40 "quarters." A quarter means one quarter of a year.

You will not get Part A free if

• You or your spouse worked less than 40 quarters of Medicaid-covered employment
• You are disabled and under 65 and lost disability benefits because you were working

If you have to pay for Part A coverage, the fee in 2005 is $393 per month. If you or a spouse worked between 30 to 39 quarters, the cost is reduced to $206 per month.

Hospital Stays

Hospital stays are covered under Medicare Part A. This includes:

• A semi-private room
• Meals
• Nursing
• Hospital services and supplies
• Inpatient mental health care (lifetime limit of 190 days)

What You Pay

Days in Hospital	You Pay
1-60	Up to $952
61-90	$228 per day
91-150	$456 per day
151 +	All costs

Skilled Nursing Facility Care

After a three-day related hospital stay:

• Semi-private room
• Meals
• Skilled nursing
• Rehabilitation (such as physical therapy)
• Other services and supplies

Skilled nursing facility care is not the same as long-term nursing home care. Medicare Part A does not cover long-term nursing home care.

What You Pay

Days in Skilled Nursing Facility	You Pay
1-20	Nothing
21-100	Up to $114
101 +	All costs

Home Health Care

Home health care benefits include:

• Part-time or intermittent skilled nursing care
• Home health aide services
• Physical and occupational therapy
• Speech therapy
• Medical social services
• Durable medical equipment (wheelchairs, walkers, etc.)
• Medical supplies

What You Pay

Nothing for Medicare-approved home health care services

20% of the Medicare-approved cost for durable medical equipment

All providers of Part A services must be certified by Medicare. If you go to a provider who is not Medicare certified, Medicare will not pay for the service. All Medicare certified providers accept Medicare and your share of costs as full payment.

Hospice Care

Hospice care is for people with a terminal illness. It covers:

• Doctors' services
• Nursing care
• Durable medical equipment (wheelchairs, walkers, etc.)
• Medical supplies (bandages, catheters, etc.)
• Drugs to control symptoms
• Drugs for pain relief
• Short-term hospital care
• Short-term respite care (although this requires a small co-payment)
• Home health aide services
• Homemaker services
• Physical and occupational therapy
• Speech therapy
• Social worker services
• Dietary counseling
• Grief and loss counseling for you and your family

Hospice care is usually given at home, but Medicare will cover "respite care." Respite care is a short-term stay at a hospice facility. This gives the usual caregiver a chance to rest. Respite care may last up to five days at a time. There is no limit to how many periods of respite care hospice patients may have.

What You Pay

No more than $5 for each prescription drug

5% of what Medicare pays for inpatient respite care per day

Blood

• Pints of blood you get in the hospital or skilled nursing facility are covered.

What You Pay

You pay for the first three pints of blood.

Unless

You or someone else you know donates three pints of blood.

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