The Centers for Medicare & Medicaid Services (CMS) sets the parameters for Medicare benefit coverage of health care services. Medicare coverage was initially designed as an acute care insurance program. Over the years, it has evolved to include more preventive services. Medicare benefit coverage is divided into three Parts: A, B, and D.
Part A is often referred to as Medicare hospital insurance and it includes:
- Skilled nursing care
- Nursing home care
- Inpatient hospital stays
- Hospice care
- Some home health services
Part B provides coverage for non-hospital physician services such as:
- Doctor visits
- Preventive care such as exams, shots, and screenings
- Outpatient services
- Medical supplies
- Tests and x-rays
- Ambulance services
- Durable Medical Equipment (DME)
- Some mental health services
- Partial hospitalization
- Second opinion before surgery
- Limited outpatient prescription drugs (e.g., certain drugs that are administered in a doctor’s office)