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

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