Medicare coverage is based on the distinction of test, procedures, and services that are a medical necessity from those that are not. This means that the only services that are covered by Medicare are the ones that they-or the local insurance company that furnished the policy-deem to be necessary for your care. This is rarely a point of concern, as most services end up being covered.
Whereas Medicare Part A covers ongoing medical procedures, the primary purpose of Medicare Part B is to cover preventative health services. These include visits with your health care provider, immunizations, vaccinations, tests, and physical and occupational therapy.
If you want to join a clinical study, Medicare Part B may cover the costs of that study, especially in cases where the treatment in the study takes the place of other treatments. In this situation, Part B covers only the routine charges, including hospital stays, operations required for the test, and the treatment of side effects that may result from the test. Part B does not cover the cost of the actual test treatment.
Mental Health Services
Part A covers inpatient mental health services, but Part B covers all outpatient mental care, as long as the services are furnished by a licensed mental health provider who accepts Medicare payments. This can include psychiatric visits, counseling with a certified therapist, help from social workers, and even midwife care.
Preventative Care, Immunizations, and Vaccinations
Flu shots fall under Medicare Part B, once a year, during flu season. Hepatitis B and pneumococcal (for infections like pneumonia) shots are also covered, if you are at risk for either disease. Most tests and visits that fall under the category of “preventative care” will also be covered. Tests like bone density screenings, cancer screenings, diabetes tests, and obesity counseling are all covered under Part B.
Your yearly “wellness visit” is also covered by Medicare, allowing you a check-up per year from the time you start Medicare until you leave it. Like any other check-up, during this visit, you can discuss current diseases, family medical history, medications, and treatment options. The main goal of these visits should be to maintain your health. Most doctors will have you fill out a health survey and use that information to create and implement a preventative health care plan. This plan may include further tests, lifestyle changes, and medications, but is ultimately designed to improve your overall health and extend that health into your later years.
A number of specific drugs are also covered by Part B, including antigens, any drug used with durable medical equipment (a pump or nebulizer used for asthma), and most “injectable” drugs. Some prescription medications for osteoporosis, hemophilia, renal disease, and immune system deficiencies are covered if the disease and the person meets specific requirements. These requirements include the seriousness of the disease and how the drug is administered.