Medicare Part B Cost. Medicare Part B Coverage
Your Medicare Part B costs are determined by a variety of factors, including the type of treatment you are undergoing. Navigating through the government bureaucracy to find out what coverage’s you currently have.
For most, the monthly premium in 2011 will be $115.40 (if you make less than $85,000 a year) and will be automatically deducted from your social security check.
What we have done is put together a complete listing of Medicare-covered services as well as your Medicare Part B cost for each service.
Abdominal Aortic Aneurysm Screening
Medicare Part B covers a one-time screening ultrasound for people at risk. Medicare only covers this screening if you get a referral for it as a result of your “Welcome to Medicare” physical exam.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. The Part B deductible doesn’t apply.
Acupuncture
Medicare does not cover acupuncture
Ambulance Services
Medicare Part B covers emergency ground transportation when you need to be transported to a hospital or skilled nursing facility for medically-necessary services, and transportation in any other vehicle could endanger your health. Medicare will pay for transportation in an airplane or helicopter if you require immediate and rapid ambulance transportation that ground transportation can’t provide. In some cases, Medicare may pay for limited non-emergency transportation if you have orders from your doctor. Medicare will only cover services to the nearest appropriate medical facility that is able to give you the care you need.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. All ambulance suppliers must accept assignment.
Ambulatory Surgical Centers
Medicare Part B covers approved surgical procedures provided in an Ambulatory Surgical Center.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Artificial Limbs and Eyes
Medicare Part B covers artificial limbs and eyes when ordered by a doctor.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Anesthesia
Medicare Part A covers anesthesia services provided by a hospital for an inpatient. Medicare Part B covers anesthesia services provided by a hospital for an outpatient or by a freestanding ambulatory surgical center for a patient.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount for the anesthesia service provided by a doctor or certified registered nurse anesthetist. The anesthesia service must be associated with the underlying medical or surgical service.
Blood
Medicare Part A covers blood you get as an inpatient. Medicare Part B covers blood you get as an outpatient or at a freestanding ambulatory surgical center. Medicare doesn’t cover the first three pints of blood you get under Part A and Part B combined in a calendar year.
In 2011 YOUR Medicare Part B cost will be paying either the provider costs for the first three pints of blood you get in a calendar year, or you must have the blood replaced if the provider has to buy blood for you. In most cases, the provider gets blood from a blood bank at no charge, and you won’t have to pay for it or replace it. You pay 20% of the Medicare-approved amount for additional pints of blood you get as an outpatient, and the Part B deductible applies.
Bone Mass Measurement
Medicare Part B covers bone mass measurements ordered by a doctor or qualified practitioner if you meet one or more of the following conditions:
Women- You are at clinical risk for osteoporosis, based on your medical history and other findings.
Men and Women:
· Your X-rays show possible osteoporosis, osteopenia, or vertebrae fractures.
· You are on prednisone or steroid-type drugs or are planning to begin such treatment.
· You have been diagnosed with primary hyperparathyroidism.
· You are being monitored to see if your osteoporosis drug therapy is working.
The test is covered once every 24 months for qualified individuals and more often if medically necessary.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. In a hospital outpatient setting, you pay a copayment.
Braces (arm, leg, back, and neck)
Medicare Part B covers arm, leg, back, and neck braces.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Breast Prosthesis
Medicare Part B covers breast prostheses (including a post-surgical brassiere) after a mastectomy.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Canes/ Crutches
Medicare Part B covers canes and crutches. Medicare doesn’t cover white canes for the blind.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Cardiac Rehabilitation Program
Medicare Part B covers comprehensive programs that include exercise, education, and counseling for patients whose doctor referred them and who had any of the following:
· A heart attack in the last 12 months
· Coronary bypass surgery
· Stable angina pectoris
· Heart valve repair/replacement
· Angioplasty or coronary stenting
· A heart or heart-lung transplant
These programs may be given by the outpatient department of a hospital or in doctor-directed clinics.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Cardiovascular Screening
Medicare Part B covers screening tests for cholesterol, lipid, and triglyceride levels every five years to help you prevent a heart attack or stroke.
In 2011 YOUR Medicare Part B cost will be paying $0 for this test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.
Chemotherapy
Medicare Part A covers chemotherapy for cancer patients who are hospital inpatients. Medicare Part B covers chemotherapy for outpatients, or patients in a doctor’s office or freestanding clinic.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount for chemotherapy in a hospital outpatient setting, doctor’s office, or freestanding clinic
Chiropractic Services
Medicare Part B covers manipulation of the spine if medically necessary to correct a subluxation (when one or more of the bones of your spine move out of position) when provided by chiropractors or other qualified providers.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Clinical Research Studies
Clinical research studies test new types of medical care, like how well a cancer drug works. These studies help doctors and researchers see if the new care works and if it’s safe. Medicare Part A and/or Part B covers some costs, like doctor visits and tests, in a qualifying clinical research study.
In 2011 YOUR Medicare Part B cost will be paying the part of the charge that you would normally pay for covered services
Colorectal Cancer Screening
Medicare Part B covers several colorectal cancer screening tests. All people age 50 and older with Medicare are covered. However, there is no minimum age for having a colonoscopy.
Colonoscopy: Medicare covers this test once every 24 months if you are at high risk for colorectal cancer. If you aren’t at high risk for colorectal cancer, the test is covered once every 120 months or 48 months after a screening flexible sigmoidoscopy.
In 2011 YOUR Medicare Part B cost will be paying only a copayment or coinsurance. The Part B deductible doesn’t apply.
Fecal Occult Blood Test: Medicare covers this lab test once every 12 months if age 50 or older.
In 2011 YOUR Medicare Part B cost will be paying $0 for this test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.
Flexible Sigmoidoscopy: Medicare covers this test once every 48 months for most people age 50 or older, or for those not at high risk, 120 months after a previous screening colonoscopy.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. The Part B deductible doesn’t apply.
Barium Enema: Once every 48 months (high risk every 24 months) when used instead of a flexible sigmoidoscopy or colonoscopy.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. The Part B deductible doesn’t apply.
Commode Chairs
Medicare Part B covers commode chairs that your doctor orders for use in your home if you are confined to your bedroom.
In 2010 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Cosmetic Surgery
Medicare generally doesn’t cover cosmetic surgery unless it’s needed because of accidental injury or to improve the function of a malformed part of the body. Medicare covers breast reconstruction if you had a mastectomy because of breast cancer.
Custodial Care
Custodial Care (help with activities of daily living, like bathing, dressing, using the bathroom, and eating)
Medicare doesn’t cover custodial care when it’s the only kind of care you need. Care is considered custodial when it helps you with activities of daily living or personal needs and could be done safely and reasonably by people without professional skills or training.
Defibrillator (Implantable Automatic)
Medicare Part A and Part B cover defibrillators for certain people diagnosed with heart failure.
In 2011 YOUR Medicare Part B cost will be paying inpatient or outpatient coinsurance and/or deductibles may apply.
Dental Services
Medicare doesn’t cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.
Medicare Part A will pay for certain dental services that you get when you are in the hospital.
Medicare Part A can pay for hospital stays if you need to have emergency or complicated dental procedures, even when the dental care isn’t covered.
Diabetes Screenings
Medicare Part B covers tests to check for diabetes. These tests are available if you have any of the following risk factors: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar. Medicare also covers these tests if you have two or more of the following:
· Age 65 or older
· Overweight
· Family history of diabetes (parents, brothers, sisters)
· A history of gestational diabetes (diabetes during pregnancy) or delivery of a baby weighing more than 9 pounds
Based on the results of these tests, you may be eligible for up to two diabetes screenings every year.
In 2011 YOUR Medicare Part B cost will be paying $0 for this test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.
Diabetes Supplies and Services
Medicare Part B covers some diabetes supplies, including the following:
· Blood sugar (glucose) test strips
· Blood sugar monitor
· Lancet devices and lancets
· Glucose control solutions for checking test strip and monitor accuracy
There may be limits on how much or how often you get these supplies. In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Insulin: Medicare doesn’t cover insulin (unless used with an insulin pump), insulin pens, syringes, needles, alcohol swabs, or gauze. Insulin and certain medical supplies used to inject insulin, such as syringes, gauze, and alcohol swabs are covered under Part D. If you use an external insulin pump, insulin and the pump could be covered as durable medical equipment.
In 2011 YOUR Medicare Part B cost will be paying 100% for insulin unless used with an insulin pump (then you pay 20% of the Medicare-approved amount) and 100% for syringes and needles, unless you have Part D.
Therapeutic Shoes or Inserts: Medicare Part B covers therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease. The doctor who treats your diabetes must certify your need for therapeutic shoes or inserts. The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist. Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year. Shoe modifications may be substituted for inserts. The fitting of the shoes or inserts is covered in the Medicare payment for the shoes.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Medicare covers these diabetes services: Diabetes Self-Management Training: Medicare Part A and Part B cover diabetes outpatient self-management training to teach you to manage your diabetes. It includes education about how you monitor your blood sugar, diet, exercise, and insulin. If you’ve been diagnosed with diabetes, Medicare may cover up to 10 hours of initial diabetes self-management training. You may also qualify for up to 2 hours of follow-up training each year if the following conditions are met:
· It’s provided in a group of 2 to 20 people.*
· It lasts for at least 30 minutes.
· It takes place in a calendar year following the year you got your initial training.
· Your doctor or a qualified non-physician practitioner ordered it as part of your plan of care.
* Some exceptions apply if no group session is available or if your doctor or qualified non-physician practitioner says you have special needs that prevent you from participating in group training.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Yearly Eye Exam: Medicare Part B covers yearly eye exams for diabetic retinopathy.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Foot Exam: Medicare Part B covers a foot exam every 6 months for people with diabetic peripheral neuropathy and loss of protective sensations, as long as you haven’t seen a foot care professional for another reason between visits.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount for outpatient facility charges or doctors’ services.
Glaucoma Tests: Medicare Part B covers glaucoma tests every 12 months for people with diabetes or a family history of glaucoma, African Americans age 50 and older, or Hispanics age 65 and older.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount
Medical Nutrition Therapy Services: Medicare Part B covers medical nutrition therapy services for people with diabetes or kidney disease when referred by a doctor. These services can be given by a registered dietitian or Medicare-approved nutrition professional. They can include a nutritional assessment and counseling to help you manage your diabetes or kidney disease.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Dialysis (Kidney) Services and Supplies
Medicare covers some kidney dialysis services and supplies:
Inpatient dialysis treatments: Medicare Part A covers dialysis if you’re admitted to the hospital for special care.
Outpatient maintenance dialysis treatments: Medicare Part B covers dialysis if you need regular treatments, and you get treatments in any Medicare-approved dialysis facility.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Certain home dialysis support services: Medicare Part B covers visits by trained dialysis workers to check on your home dialysis, to help in dialysis emergencies when needed, and to check your dialysis equipment and hemodialysis water supply.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. Only dialysis facilities can furnish home dialysis support services.
Erythropoiesis–stimulating Agents: Medicare covers agents like Epogen®, Procrit®, Epoetin alfa, Arnesp®, or Darbepoetin alfa to treat anemia if you have End-Stage Renal Disease.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Self-dialysis training: Medicare Part B covers training for you and the person helping you with your home dialysis treatments.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. If you deal with a dialysis facility, the cost of home dialysis equipment and supplies is included in the cost of dialysis. If you deal with a medical supply company, it (not the dialysis facility) must accept assignment.
Home dialysis equipment and supplies: Medicare Part B covers equipment and supplies like alcohol, wipes, sterile drapes, rubber gloves, and scissors.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Doctor’s Services
Medicare Part B covers medically-necessary services you get from your doctor in his or her office, in a hospital, in a skilled nursing facility, in your home, or any other location. Medicare doesn’t cover routine annual physicals, except the one-time “Welcome to Medicare” physical exam.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Durable Medical Equipment (DME)
Medicare Part B covers Durable Medical Equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you.
Durable Medical Equipment meets the following criteria:
· Durable (Long lasting)
· Used for a medical reason
· Not usually useful to someone who isn’t sick or injured
· Used in your home
The DME that Medicare covers includes, but isn’t limited to, the following:
· Air-fluidized beds
· Blood sugar monitors
· Canes (canes for the blind aren’t covered)
· Commode chairs
· Crutches
· Dialysis machines
· Home oxygen equipment and supplies
· Hospital beds
· Infusion pumps (and some medicines used in infusion pumps if considered reasonable and necessary)
· Nebulizers (and some medicines used in nebulizers if considered reasonable and necessary)
· Patient lifts (to lift patient from bed or wheelchair by hydraulic operation)
· Suction pumps
· Traction equipment
· Walkers
· Wheelchairs
Make sure your doctor or supplier is enrolled in Medicare. In some cases, you may have to use a contract supplier.Doctors and other suppliers have to meet strict standards to enroll and stay enrolled in the Medicare Program.
If your doctor or supplier isn’t enrolled, Medicare won’t pay the claim submitted by your doctor or supplier, even if your supplier is a large chain or department store that sells more than just durable medical equipment.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. Medicare pays for different kinds of DME in different ways; some equipment must be rented, other equipment may be purchased, and you may choose to rent or buy some equipment. If a DME supplier doesn’t accept assignment, Medicare doesn’t limit how much the supplier can charge you. You also may have to pay the entire bill (your share and Medicare’s share) at the time you get the DME.
Note: Ask if the supplier is a participating supplier in the Medicare Program before you get Durable Medical Equipment. If the supplier is a participating supplier, it must accept assignment. If the supplier is enrolled in Medicare but isn’t “participating,” it may choose not to accept assignment.
Emergency Room Services
Medicare Part B covers emergency room services. Emergency services may be covered in foreign countries only in rare circumstances. A medical emergency is when you believe that you have an injury or illness that requires immediate medical attention to prevent a disability or death.
In 2011 YOUR Medicare Part B cost will be paying a copayment for each emergency room visit unless you are admitted to the same hospital for the same condition within 3 days of your emergency room visit.
When you go to an emergency room, you pay a specified copayment for each hospital service. You also pay a coinsurance of 20% of the Medicare-approved amount for each doctor who treats you.
Eye Exams
Medicare doesn’t cover routine eye exams (refractions) for eye glasses/contacts. Medicare covers some preventive and diagnostic eye exams.
· See yearly eye exams under Diabetes Supplies and Services
· See Glaucoma Tests
· See Macular Degeneration
Eyeglasses/ Contact Lenses
Generally, Medicare doesn’t cover eyeglasses or contact lenses. However, following cataract surgery with an implanted intraocular lens, Medicare Part B helps pay for corrective lenses (eyeglasses or contact lenses).
In 2011 YOUR Medicare Part B cost will be paying 100%, in general. You pay 20% of the Medicare-approved amount for one pair of eyeglasses or contact lenses after each cataract surgery with an intraocular lens. You pay any additional cost for upgraded frames.
Eye Refractions
Medicare doesn’t cover routine eye refractions for eye glasses/contacts. See Eye Exams.
Flu Shots
Medicare Part B normally covers one flu shot per flu season in the fall or winter.
In 2011 YOUR Medicare Part B cost will be paying $0 for a flu shot if the doctor or supplier accepts assignment for administering the shot. If the doctors or supplier doesn’t accept assignment, you pay 20% of the Medicare-approved amount.
Foot Care
Medicare Part B covers the services of a podiatrist (foot doctor) for medically-necessary treatment of injuries or diseases of the foot (such as hammer toe, bunion deformities, and heel spurs), but it doesn’t cover routine foot care. See Therapeutic Shoes and Foot Exam for more information.
In 2011 YOUR Medicare Part B cost will be paying 100% for routine foot care, in most cases. You pay 20% of the Medicare-approved amount for medically-necessary treatment.
Glaucoma Tests
Medicare Part B covers a glaucoma test once every 12 months for people at high risk for glaucoma. This includes people with diabetes, a family history of glaucoma, African Americans age 50 and older, or Hispanic Americans age 65 and older. The screening must be done or supervised by an eye doctor who is legally allowed to do this in your state.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Health Education/ Wellness Programs
Medicare generally doesn’t cover health education and wellness programs. However, Medicare does cover medical nutrition therapy for people with diabetes or kidney disease and diabetes education for people with diabetes, counseling to stop smoking, and a one-time “Welcome to Medicare” physical exam.
Hearing and Balance Exams / Hearing Aids
In some cases, Medicare Part B covers diagnostic hearing and balance exams. Medicare doesn’t cover routine hearing exams, hearing aids, or exams for fitting hearing aids.
In 2011 YOUR Medicare Part B cost will be paying 100% for routine exams and hearing aids. You pay 20% of the Medicare-approved amount for covered exams.
Hepatitis B Shots
Medicare Part B covers this shot for people at high or medium risk for Hepatitis B. Your risk for Hepatitis B increases if you have hemophilia, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant), or a condition that lowers your resistance to infection. Other factors may also increase your risk for Hepatitis B. Check with your doctor to see if you are at high or medium risk for Hepatitis B.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount for the Hepatitis B shots given in a doctor’s office. You pay a copayment for a Hepatitis B shot given in a hospital outpatient department.
Home Health Services
If you have Medicare, you can use your home health benefits under Medicare Part A and/or Part B if you meet all the following conditions:
· Your doctor must decide that you need medical care at home, and make a plan for this care.
· You must need at least one of the following, qualifying skilled services:
1. Intermittent skilled nursing care (other than just drawing blood)
2. Physical therapy
3. Speech-language pathology services
4. Continued occupational therapy
· The home health agency caring for you must be approved by Medicare (Medicare-certified).
· You must be homebound, meaning that you are normally unable to leave home unassisted. When you do leave the home, it’s a considerable and taxing effort. A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as a trip to attend religious services. You can still get home health care if you attend adult day care
Note: Home health services may also include part-time or intermittent home health aide services, medical social services, medical supplies, durable medical equipment, and an injectable osteoporosis drug.
In 2011 YOUR Medicare Part B cost will be paying $0 for all covered home health visits.
Osteoporosis Drugs for Women: Medicare Part A and Part B help pay for an injectable drug for osteoporosis in women who are eligible for Medicare Part B, meet the criteria for the Medicare home health benefit, and have a bone fracture that a doctor certifies was related to post-menopausal osteoporosis. You must also be certified by a doctor as unable to learn or unable to give yourself the drug by injection, and that family and/or caregivers are unable or unwilling to give the drug by injection. Medicare covers the visit by a home health nurse to give the drug.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount of the drug. You pay $0 for the home health nurse visit to give the drug
Hospice Care
Medicare Part A covers hospice care if you meet all of the following conditions:
· You are eligible for Medicare Part A.
· Your doctor certifies that you are terminally ill and probably have less than 6 months to live.
· You accept palliative care (for comfort) instead of care to cure your illness.
· You sign a statement choosing hospice care instead of routine Medicare-covered benefits for your terminal illness.
· In a Medicare-approved hospice, nurse practitioners aren’t permitted to certify the patient’s terminal diagnosis, but after a doctor certifies the diagnosis, the nurse practitioner can serve in place of an attending doctor.
You can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies that you are terminally ill.
Inpatient Respite Care: Respite care is inpatient care given to a hospice patient so that the usual caregiver can rest. You can stay in a Medicare-approved facility, such as a hospice facility, hospital, or nursing home, up to 5 days each time you get respite care.Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.
In 2011 YOUR Medicare Part B cost will be paying $0 for hospice care. You may need to pay a copayment of up to $5 for outpatient prescription drugs for symptom control or pain relief. Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).In certain cases, if the hospice staff determines that you need inpatient care in a hospice facility or your caregiver needs a short period of respite, the costs for room and board are included in Medicare’s payment. You pay 5% of the Medicare-approved amount for inpatient respite care.
Hospital Care (Inpatient)
Medicare Part A covers inpatient hospital care when all of the following are true:
· A doctor says you need inpatient hospital care to treat your illness or injury.
· You need the kind of care that can be given only in a hospital.
· The hospital accepts Medicare.
· The Utilization Review Committee of the hospital approves your stay while you are in the hospital.
Medicare-covered hospital services include the following: a semiprivate room, meals, general nursing, and other hospital services and supplies. This includes care you get in critical access hospitals and inpatient mental health care. This doesn’t include private-duty nursing, a television, or a telephone in your room. It also doesn’t include a private room, unless medically necessary.
In 2011 YOUR Medicare Part B cost will be paying for each benefit period:
Days 1 - 60: $1,024 deductible
Days 61 - 90: $256 coinsurance each day
Days 91 - 150: $512 coinsurance each day
Beyond 150 days: all costs
You pay for private-duty nursing, a television, or a telephone in your room. You pay for a private room unless it’s medically necessary.
Laboratory Services (Clinical)
Medicare Part B covers medically-necessary diagnostic lab services that are ordered by your treating doctor. They must be provided by a laboratory that meets Medicare requirements.
In 2011 YOU pay $0 for Medicare-approved lab services.
Macular Degeneration
Medicare Part B covers certain diagnoses and treatment of diseases and conditions of the eye for some patients with age-related macular degeneration (AMD) like ocular photodynamic therapy with verteporfin (Visudyne®).
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Mammograms
Medicare Part B covers a screening mammogram once every 12 months (11 full months must have gone by from the last screening) for all women with Medicare age 40 and older. You can also get one baseline mammogram between ages 35 and 39.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. The Part B deductible doesn’t apply. Medicare Part B covers diagnostic mammograms when medically necessary.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Mental Health Care
Medicare Part A and Part B cover mental health services in a variety of settings.
Inpatient Mental Health Care: Medicare Part A covers inpatient mental health care services. These services can be given in hospitals, including specialized psychiatric units, or specialized psychiatric hospitals. Medicare helps pay for inpatient mental health services in the same way that it pays for all other inpatient hospital care.
Note: If you are in a specialty psychiatric hospital, Medicare only helps pay for a total of 190 days of inpatient care during your lifetime.
In 2011 YOU pay the same deductible and copayments as inpatient hospital care.
Outpatient Mental Health Care: Medicare Part B covers mental health services on an outpatient basis when provided by a doctor, clinical psychologist, clinical social worker, nurse practitioner, clinical nurse specialist, or physician assistant in an office setting, clinic, or hospital outpatient department.
In 2011 YOU pay usually 50% of the Medicare-approved amount for some professional mental health treatment services such as individual or group psychotherapy. You also pay a copayment or coinsurance for the facility service when provided in a hospital outpatient department or clinic.
Partial Hospitalization: Medicare Part B covers partial hospitalization in some cases. It’s a structured program of outpatient active psychiatric treatment that is more intense than the care you get in your doctor’s or therapist’s office. To be eligible for a partial hospitalization program, a doctor must certify that you would otherwise need inpatient treatment. Medicare covers the services of qualified non-physician practitioners such as clinical psychologists, clinical social workers, nurse practitioners, clinical nurse specialists, and physician assistants, as allowed by state and local law for medically-necessary services.
In 2011 YOU pay a set copayment amount for each day of service. You also pay a copayment or coinsurance for the facility service when provided in a hospital outpatient department or community mental health center.
Nursing Home Care
Most nursing home care is custodial care (such as help with bathing or dressing). Medicare doesn’t cover custodial care if that’s the only care you need. However, if it’s medically necessary for you to have skilled care (like changing sterile dressings), Medicare Part A will pay for care given in a certified skilled nursing facility (SNF).
Nutrition Therapy Services (Medical)
Medicare Part B covers medical nutrition therapy services, when ordered by a doctor, for people with kidney disease (but who aren’t on dialysis) or who have a kidney transplant, or people with diabetes. If you get dialysis in a dialysis facility,Medicare covers medical nutrition therapy as part of your overall dialysis care. These services can be given by a registered dietitian or Medicare-approved nutrition professional. Services may include nutritional assessment, one-on-one counseling, and therapy through an interactive telecommunications system.
In 2011 YOU pay 20% of the Medicare-approved amount.
Nutrition Therapy Services (Medical)
Medicare Part B covers medical nutrition therapy services, when ordered by a doctor, for people with kidney disease (but who aren’t on dialysis) or who have a kidney transplant, or people with diabetes. If you get dialysis in a dialysis facility, Medicare covers medical nutrition therapy as part of your overall dialysis care. These services can be given by a registered dietitian or Medicare-approved nutrition professional. Services may include nutritional assessment, one-on-one counseling, and therapy through an interactive telecommunications system.
In 2011 YOU pay 20% of the Medicare-approved amount.
Oral Anti-Nausea Drugs
Medicare will help pay for oral anti-nausea drugs used as part of an anti-cancer chemotherapeutic regimen. The drugs must be administered within 48 hours and must be used as a full therapeutic replacement for the intravenous anti-nausea drugs that would otherwise be given.
In 2011 YOU pay 100% for most prescription drugs you take at home, unless you have Part D. You pay coinsurance or a copayment for prescription drugs that you are given when you are in a doctor’s office or hospital outpatient department. You pay 20% of the Medicare-approved amount for covered prescription drugs. Coverage under Part B is limited.
Orthotics
Medicare Part B covers artificial limbs and eyes, and arm, leg, back and neck braces. Medicare doesn’t pay for orthopedic shoes unless they are a necessary part of the leg brace. Medicare doesn’t pay for dental plates or other dental devices. See Diabetes Supplies and Services (Therapeutic Shoes) for more information.
In 2011 YOU pay 20% of the Medicare-approved amount.
Ostomy Supplies
Medicare Part B covers ostomy supplies for people who have had a colostomy, ileostomy, or urinary ostomy. Medicare covers the amount of supplies your doctor says you need, based on your condition.
In 2011 YOU pay 20% of the Medicare-approved amount for the doctor’s services and supplies.
Outpatient Hospital Services
Medicare Part B covers medically-necessary services you get as an outpatient from a Medicare-participating hospital for diagnosis or treatment of an illness or injury. Covered outpatient hospital services include the following:
· Services in an emergency room or outpatient clinic, including same-day surgery
· Laboratory tests billed by the hospital
· Mental health care in a partial-hospitalization program, if a doctor certifies that inpatient treatment would be required without it
· X-rays and other radiology services billed by the hospital
· Medical supplies such as splints and casts;
· Screenings and preventive services
· Certain drugs and biologicals that you can’t give yourself
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount for the doctor. For other than doctors’ services, you pay a copayment for each service you get in an outpatient hospital setting.
Oxygen Therapy
Medicare Part B covers the rental of oxygen equipment. Or, if you own your own equipment, Medicare will help pay for oxygen contents and supplies for the delivery of oxygen when all of the conditions below are met. Your doctor says you have a severe lung disease, or you’re not getting enough oxygen and your condition might do the following:
· Improve with oxygen therapy
· Your arterial blood gas level falls within a certain range
· Other alternative measures have failed
· Under the above conditions Medicare helps pay for the following:
· Systems for furnishing oxygen
· Containers that store oxygen
· Tubing and related supplies for the delivery of oxygen, and oxygen contents
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Pap Test/ Pelvic Exam (Screening)
Medicare Part B covers Pap tests and pelvic exams (and a clinical breast exam) for all women once every 24 months.Medicare covers this test and exam once every 12 months if you are at high risk for cervical or vaginal cancer or if you are of childbearing age and have had an abnormal Pap test in the past 36 months. Routine physical exams aren’t covered by Medicare, except for the one-time “Welcome to Medicare” physical exam.
In 2011 YOU pay $0 for the lab Pap test. You pay 20% of the Medicare-approved amount for the part of the exam when the doctor or other health care provider collects the specimen. If the pelvic exam was provided in a hospital outpatient department, you pay a copayment.
If you have your Pap test, pelvic exam, and clinical breast exam in the same visit as a routine physical exam, you must pay for the physical exam.
Physical Exams (routine) (One-time “Welcome to Medicare” physical exam)
Medicare Part B covers a one-time “Welcome to Medicare” physical exam, which includes a review of your health, as well as education and counseling about the preventive services you need, including certain screenings and shots. Referrals for other care, if you need it, may also be included. Medicare doesn’t cover routine physical exams.
Important: You must have the physical exam within the first 12 months you have Medicare Part B. The Part B deductible doesn’t apply.
You pay 20% of the Medicare-approved amount for the “Welcome to Medicare” physical exam.
Physical Therapy/ Occupational Therapy/Speech-Language Pathology Service
Medicare Part B helps pay for medically-necessary outpatient physical and occupational therapy and speech-language pathology services when both of these conditions are met:
· Your doctor or therapist sets up the plan of treatment.
· Your doctor periodically reviews the plan to see how long you will need therapy.
You can get outpatient services from a Medicare-approved outpatient provider such as a participating hospital or skilled nursing facility, or from a participating home health agency, rehabilitation agency, or a comprehensive outpatient rehabilitation facility. Also, you can get services from a Medicare-approved physical or occupational therapist, in private practice, in his or her office, or in your home.
As of July 1, 2009, Medicare now pays for services given by a speech-language pathologist in private practice. (Our thanks to Dr. Steven C. White of the Amercian Speech-Language-Hearing Association for providing this update to us).
In 2010, there may be limits on physical therapy, occupational therapy, and speech-language pathology services. If so, there may be exceptions to these limits.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Pneumococcal Shot
Medicare Part B covers a pneumococcal shot to help prevent pneumococcal infections (like certain types of pneumonia). Most people only need this preventive shot once in their lifetime. Talk with your doctor to see if you need this shot.
In 2011 YOUR Medicare Part B cost will be paying $0 for a pneumococcal shot if the doctor or supplier accepts assignment for administering the shot.
Practitioner Services (Non-physician)
Medicare Part B covers certain services provided by clinical social workers, physician assistants, and nurse practitioners.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Prescription Drugs (Outpatient) Limited Coverage
Part B covers a limited number of outpatient prescription drugs. Your pharmacy or doctor must accept assignment on prescription drugs covered under Part B.
Part B covers drugs that aren’t usually self-administered when you are given them in a hospital outpatient department or doctor’s office.
Generally, Medicare doesn’t cover self-administered drugs you get in an outpatient setting like an emergency room or observation unit.
You can get comprehensive drug coverage by joining a Medicare drug plan (also called “Part D”).
For example, the following outpatient prescription drugs are covered:
· Drugs infused through an item of durable medical equipment, such as an infusion pump or nebulizer if considered reasonable and necessary.
· Some Antigens: Medicare will help pay for antigens if they are prepared by a doctor and given by a properly-instructed person (who could be the patient) under doctor supervision.
· Osteoporosis Drugs: Medicare helps pay for an injectable drug for osteoporosis for certain women with Medicare.
· Erythropoisis–stimulating Agents (such as Epogen®, Procrit®, Epoetin alfa, or Aranesp®, Darbepoetin alfa):Medicare will help pay for erythropoietin by injection if you have End-Stage Renal Disease (permanent kidney failure) or need this drug to treat anemia related to certain other conditions.
· Blood Clotting Factors: If you have hemophilia, Medicare will help pay for clotting factors you give yourself by injection.
· Injectable Drugs: Medicare covers most injectable drugs given by a licensed medical practitioner, if the drug is considered reasonable and necessary for treatment.
· Immunosuppressive Drugs: Medicare covers immunosuppressive drug therapy for transplant patients if the transplant was paid for by Medicare (or paid by private insurance that paid as a primary payer to your Medicare Part A coverage) in a Medicare-certified facility.
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.
Oral Cancer Drugs: Medicare will help pay for some cancer drugs you take by mouth if the same drug is available in injectable form. Currently, Medicare covers the following cancer drugs you take by mouth:
· Capecitabine (Xeloda®)
· Busulfan (Myleran®)
· Cyclophosphamide (Cytoxan®)
· Etoposide (VePesid®)
· Methotrexate (Rheumatrex®)
· Melphalan (Alkeran®)
· Temozolomide (Temodar®)
As new cancer drugs become available, Medicare may cover them.
Preventive Services
Medicare Part B covers the following preventive and screening services that may help prevent illness or detect illness at an early stage, when treatment is likely to work best:
· Abdominal Aortic Aneurysm Screening
· Bone Mass Measurement
· Cardiovascular Screening Blood Tests
· Colorectal Cancer Screening
· Diabetes Screening
· Diabetes Self-Management Training
· Glaucoma Tests
· Mammogram (screening)
· Medical Nutrition Therapy Services
· One-time “Welcome to Medicare” physical exam
· Pap Test/Pelvic Exam (screening)
· Prostate Cancer Screening
· Shots 50 including the following:
· Flu Shot
· Pneumococcal Shot
· Hepatitis B Shot
In 2011 YOUR Medicare Part B cost will be paying the cost listed on the page for that specific service.
Prostate Cancer Screenings
Medicare Part B covers prostate cancer screening tests once every 12 months for men with Medicare age 50 and older. Coverage begins the day after your 50th birthday. Covered tests include the following:
Digital Rectal Examination - In 2011 YOU pay generally, 20% of the Medicare-approved amount for the digital rectal exam.
Prostate Specific Antigen (PSA) Test - In 2011 YOU pay $0 for the PSA test.
Prosthetic Devices
Medicare Part B covers prosthetic devices needed to replace an internal body part or function. These include Medicare-approved corrective lenses needed after a cataract operation (see Eyeglasses/Contact Lenses), ostomy bags and certain related supplies (see Ostomy Supplies), and breast prostheses (including a surgical brassiere) after a mastectomy (see Breast Prosthesis).
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Religious Nonmedical Health Care Institution (RNHCI)
Medicare doesn’t cover the religious portion of RNHCI care. Medicare Part A covers inpatient nonmedical care when the following conditions are met:
· The RNHCI has agreed and is currently certified to participate in Medicare, and the Utilization Review Committee agrees that you’d require hospital or skilled nursing facility care if it weren’t for your religious beliefs.
· You have a written agreement with Medicare indicating that your need for this form of care is based on your religious beliefs. The agreement must also indicate that if you decide to accept standard medical care, you may have to wait longer to get RNHCI services in the future. You’re always able to access medically-necessary Medicare Part A services.
· The care provided is reasonable and necessary.
In 2011 YOU pay for each benefit period you pay:
· Days 1 - 60: $1,024 deductible
· Days 61 - 90 $256 coinsurance each day
· Days 91 - 150: $512 coinsurance each day
· Beyond 150 days: all costs
Respite Care (Inpatient)
Medicare Part A covers respite care (inpatient care given to a hospice patient so that the usual caregiver can rest) for hospice patients. See Hospice Care.
In 2011 YOUR Medicare Part B cost will be paying 5% of the Medicare-approved amount
Rural Health Clinic and Federally-Qualified Health Center Services
Medicare Part B covers a broad range of primary care services usually provided on an outpatient basis.
In 2011 YOU pay 20% of the Medicare-approved amount.
Second Surgical Opinions
Medicare Part B covers a second opinion before surgery that isn’t an emergency. A second opinion is when another doctor gives his or her view about your health problem and how it should be treated. Medicare will also help pay for a third opinion if the first and second opinions are different.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Skilled Nursing Facility (SNF) Care
Medicare Part A covers skilled care in a skilled nursing facility (SNF) under certain conditions for a limited time. Skilled care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Medicare covers certain skilled care services that are needed daily on a short-term basis (up to 100 days).
In 2011 YOU pay for each benefit period (following at least a related 3-day covered hospital stay):
· Days 1 - 20: $0 each day
· Days 21 - 100: up to $128 each day
· Beyond 100 days: You pay 100%.
There is a limit of 100 days of Medicare Part A SNF coverage in each benefit period.
Medicare will cover skilled care if all these conditions are met:
1. You have Medicare Part A (Hospital Insurance) and have days left in your benefit period to use.
2. You have a qualifying hospital stay. This means an inpatient hospital stay of 3 consecutive days or more, including the day you’re admitted to the hospital, but not including the day you leave the hospital. You must enter the SNF within a short time (generally 30 days) of leaving the hospital and require skilled services related to your hospital stay. See item 5. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you don’t need another 3-day qualifying hospital stay to get additional SNF benefits. This is also true if you stop getting skilled care while in the SNF and then start getting skilled care again within 30 days.
3. Your doctor has decided that you need daily skilled care. It must be given by, or under the direct supervision of, skilled nursing or rehabilitation staff. If you are in the SNF for skilled rehabilitation services only, your care is considered daily care even if these therapy services are offered just 5 or 6 days a week, as long as you need and get the therapy services each day they are offered.
4. You get these skilled services in a SNF that is certified by Medicare.
5. You need these skilled services for a medical condition that was either of the following:
– Treated during a qualifying 3-day hospital stay.
– Started while you were getting care in the SNF for a hospital-related medical condition. For example, Medicare will cover skilled care if you are in the SNF because you had a stroke, and you develop an infection that requires IV antibiotics, and you meet the conditions listed in items 1–4 listed earlier.
While you are in a non-covered stay in the Medicare-certified part of the facility, your Part B therapy services (physical therapy, occupational therapy, and speech-language pathology) must be billed by the facility. No other therapy service may be billed by another setting, such as an outpatient hospital department. If you leave the Medicare-certified part of the facility, your therapy services in the non-Medicare-certified part of the facility are limited by a specific dollar amount each year unless you get the services from an outpatient hospital setting.
Smoking Cessation (counseling to stop smoking)
Medicare Part B covers up to 8 face-to-face visits in a 12-month period if you are diagnosed with an illness caused or complicated by tobacco use, or you take a medicine that is affected by tobacco.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
Supplies (you use at home)
Medicare Part B generally doesn’t cover common medical supplies like bandages and gauze. Medicare covers some diabetes and dialysis supplies.
In 2011 YOUR Medicare Part B cost will be paying 100% for most common medical supplies you use at home, in general.
Surgical Dressing Services
Medicare Part B covers medically-necessary treatment of a surgical or surgically-treated wound.
In 2011 YOU pay 20% of the Medicare-approved amount for doctor services.
Telemedicine
Telemedicine is medical or other health services given to a patient using a communications system (like a computer, telephone, or television) by a practitioner in a location different than the patient’s.
Medicare Part B covers telemedicine in some rural areas, under certain conditions and only in a provider’s office, a hospital, or a Federally-qualified health center.
In 2011 YOU pay 20% of the Medicare-approved amount for doctor services.
Transplants (Doctor Services)
Medicare Part B covers doctor services for transplants, see Transplants (Facility Charges).
In 2011 YOU pay 20% of the Medicare-approved amount for doctor services.
Transplants (Facility Charges)
Medicare Part A covers transplants of the heart, lung, kidney, pancreas, intestine, and liver under certain conditions and only at Medicare-approved facilities. Medicare only approves facilities for kidney, heart, liver, lung, intestine, and some pancreas transplants. Medicare Part B covers cornea and bone marrow transplants. Bone marrow and cornea transplants aren’t limited to approved facilities.
Transplant coverage includes necessary tests, labs, and exams before surgery. It also includes immunosuppressive drugs (under certain conditions), follow-up care for you, and procurement of organs and tissues. Medicare pays for the costs for a living donor for a kidney transplant.
In 2011 YOU pay various amounts. For Inpatient Transplants, see Hospital Care (Inpatient)
Transportation (Routine)
Medicare doesn’t cover transportation to get routine health care. For more information, see Ambulance Services.
Travel (health care needed when traveling outside the United States)
Medicare generally doesn’t cover health care while you are traveling outside the United States. Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands are considered part of the United States. There are some exceptions. In some cases, Medicare Part B may pay for services that you get while on board a ship within the territorial waters adjoining the land areas of the United States. In rare cases, Medicare Part A may pay for inpatient hospital services that you get in a foreign country under the following circumstances:
· You are in the United States when a medical emergency occurs and the foreign hospital is closer than the nearest United States hospital that can treat the emergency.
· You are traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs and the Canadian hospital is closer than the nearest United States hospital that can treat the emergency.
· You live in the United States and the foreign hospital is closer to your home than the nearest United States hospital that can treat your medical condition, regardless of whether an emergency exists.
Medicare also pays for doctor and ambulance services you get in a foreign country as part of a covered inpatient hospital stay. In 2011 YOU pay 100% of charges, in most cases. In the situations described above, you pay the part of the charge that you would normally pay for covered services.
Walker/ Wheelchair
Medicare Part B covers power-operated vehicles (scooters), walkers, and wheelchairs as durable medical equipment that your doctor prescribes for use in your home. For more information, see Durable Medical Equipment.
Power Wheelchair: You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay for a power wheelchair.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount.
X-Rays
Medicare Part B covers medically-necessary diagnostic X-rays that are ordered by your treating doctor. For more information, see Diagnostic Tests.
In 2011 YOUR Medicare Part B cost will be paying 20% of the Medicare-approved amount. For X-rays in a hospital outpatient setting, you pay a copayment
