What Is Covered – Part B

• · 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 begin_of_the_skype_highlighting            1-800-633-4227     end_of_the_skype_highlighting for more information. TTY users should call 1-877-486-2048 begin_of_the_skype_highlighting            1-877-486-2048     end_of_the_skype_highlighting.
• · 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.

Jim Bigelow 918-640-4657      www.jimbigelow.com                    jim@jimbigelow.com

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