What’s Covered by Original Medicare (Parts A and B)?
Medicare covers services (like lab tests, surgeries and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.
If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
Original Medicare covers many valuable services for people who are ill, recovering or in the final stages of their lives. These are services you might not need today, but preparing for what may happen 5, 10 or 20 years from now will give you peace of mind.
Explore some of your options if you sign up for Original Medicare.
Home health aides can help you bathe, use the toilet, take your drugs and do other daily activities. But Medicare only covers these services when you also need and get skilled nursing care or rehabilitative care. You can’t get more than 35 hours a week of nursing and home health aide care. Usually Medicare covers up to 28 hours a week of this kind of care.
Medicare offers a benefit for those nearing the end of life, called hospice care. This benefit is optional, so you must choose to receive this care. For you to qualify for hospice, a doctor must certify that you have 6 months or less to live. When you choose hospice care, you only waive your rights to Medicare benefits that would cover treatment of your terminal illness.
Medicare hospice benefits are covered if:
- You are eligible for Medicare Hospital Insurance (Part A), and
- Your doctor and the hospice medical director both certify that you are
- Terminally ill;
- Expected to die within 6 months; and
- You choose hospice care and waive your right to other Medicare-covered benefits to treat your terminal illness, and
- You get care from a hospice program that Medicare approves.
Talk with your medical team before you start to get any of these services. Make sure Medicare approves your hospice or you may have to pay the entire cost of these services.
Physical, speech-language and occupational therapy: You can get treatments to help you improve or maintain your ability to move, talk, swallow and do daily activities for as long as your doctor says you need them. These are called physical therapy and speech and language therapy services. If you get this kind of skilled therapy at home, you can also qualify for home health aide care.
Respite care is temporary care that lets the family member or friend who cares for your take time off to rest. You can stay in a setting Medicare approves for up to 5 days each time you get respite care. This may include a hospice inpatient facility, hospital or nursing home. And you can get respite care as many times as you need it.
Skilled nursing care
A nurse can come to your home to treat your illness or injury. This is covered on a part-time basis. You can only get this care from a registered or licensed practical nurse. Medicare pays for a nurse to watch you and see if your condition changes. It also pays for a nurse to teach you and your caregivers how to take care of you.
What can I do if Medicare does not cover a service?
If Medicare decides not to cover your service, you have a right to know why. You should first speak to your provider and then with an advisor with Medicare. Regardless of the reason for the decision, you can appeal if you do not agree with Medicare.