Medicare Coverage: What does Medicare Cover? (cont.)

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.

Medicare Part B

To enroll in Part B, most people pay a premium each month. In 2005, the monthly fee is $78.20. If you sign up late, the cost will be higher.

Medical and Other Services

  • Doctors' services (including office visits, but not routine physical exams)
  • Outpatient medical and surgical services and supplies
  • Diagnostic tests
  • Ambulatory surgery center facility fees for approved procedures
  • Durable medical equipment (such as wheelchairs, walkers, etc.)
  • Second and sometimes third surgical opinions
  • Outpatient mental health care
  • Outpatient occupational and physical therapy
  • Speech therapy
What You Pay
$124 annual deductible in 2005
20% of Medicare-approved amount after the deductible and 100% of charges above the approved amount
50% of most outpatient mental health costs

The Medicare-approved amount is what Medicare has decided it will pay for an item or service. Doctors may charge 15% above the approved amount. In some cases, health care providers and suppliers are required by law to accept the Medicare-approved amount. Any amount over the approved cost is not covered. For example:

After You Reach Your Deductible
Medicare-Approved Cost If You Are Billed You Pay
$100 $100 $20
$100 $150 $70

Laboratory and Radiology Services

Clinical lab services are covered, including:

  • Blood tests
  • Clinical diagnostic tests
  • X-rays, CT scans, MRI scans, and EKG tests
  • Urinalysis
  • Some routine screening tests (see Preventive Services)

What You Pay

You pay nothing for these services.

Outpatient Hospital Services

  • Medicare Part B covers services and supplies you get while being treated as an outpatient in a hospital.

What You Pay

You pay a co-payment. The amount varies depending on the type of service or supply.

Blood

  • Pints of blood you get for transfusions are covered.
What You Pay
You pay for the first three pints of blood you get.
20% of the approved cost for more than three pints
Unless
You or someone you know donates blood to replace what you used.

Preventive Services

Medicare covers the following preventive services:

Service How Often Who Can Get It
Bone mass measurements (to look for bone thinning osteoporosis) Once every two years (or more if needed) People at risk of osteoporosis
Cardiovascular Screening Blood Tests (including tests of cholesterol, lipids, triglycerides, and other markers of cardiovascular disease) Every 5 years. Ask your doctor
Colorectal Cancer Screening (includes one or more of the following tests: colonoscopy, fecal occult blood test, flexible sigmoidoscopy, and/or a barium enema. Depends on your risk. Ask your doctor. People who age 50 or older or who are at high risk of colorectal cancer.
Diabetes Screening Tests (tests of blood glucose levels) Ask your doctor. You may be eligible for up to two screenings each year. Certain people who are at risk for diabetes
Digital rectal exam (a prostate cancer screening test) Once a year Men aged 50 and older
Flu shot (vaccination) Once a year in fall or winter Everyone
Glaucoma testing (a vision-robbing condition) Once a year People who are at high risk of glaucoma.
Hepatitis B shot (vaccination) N/A Certain people at risk for Hepatitis B
Mammogram Once a year All women aged 40 and older
Pap test and pelvic exam, includes breast exam Once every two years; or once a year if you are at high risk All women
Pneumonia shot (vaccination) Ask your doctor Everyone
Prostate Cancer Screening (digital rectal exam and PSA test) Once a year Men aged 50 and older
"Welcome to Medicare" Physical Examination (includes measurements of height, weight, blood pressure, an EKG, education and counseling.) One time only Everyone whose Part B coverage began after January 1, 2005

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