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Original Fee-For-Service Medicare: Part A and Part B: Schedule Of Benefits


Medicare is divided into two parts:

  • Medicare Part A -- insurance for hospital stays. 
    • The coverage includes inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals. 
    • Part A does not include long-term or custodial care such a care in a nursing home unless custodial care is not the only care that you need.
    • If you meet specific requirements, you may also be eligible for hospice or home health care. 
    • The federal government pays Part A premiums for most Medicare beneficiaries. Part A coverage may also be purchased.
    • For a list of covered services and benefits, click here offsite link.
  • Medicare Part B -- insurance for the rest of medical care, such as visits to doctors and out-patient procedures.   
    • Medicare Part B is considered voluntary so to get Part B coverage, you have to pay for it.  The amount of what you have to pay depends on the amount of your income. (To learn more about Medicare premiums, see: Original Fee-For-Service Medicare: Premiums)
    • For a list of covered services and benefits, click here offsite link

Because the following are not paid for by either Medicare Part A or Part B, (in addition to premiums) your out-of-pocket costs for health care will include, but are not limited to:

  • Deductiblescoinsurance or copayments when you get health services.
  • Dental care and dentures in most cases.Cosmetic surgery (except following a mastectomy as noted above).
  • Custodial care (help with bathing, dress, toileting, and eating) at home or in a nursing home except as covered under Home Health and Hospice benefits.
  • Full-time nursing care in the home.
  • Private duty nurse.
  • Extra charges for a private room.
  • Personal comfort items.
  • Health care you get while traveling outside of the United States.  If you travel in any of the 50 states, District of Columbia, Commonwealth of Puerto Rico, Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands, you will be covered by Medicare.
  • Hearing aids or testing for their fitting.
  • Orthopedic shoes.
  • Outpatient prescription drugs except immunosuppressive drugs for transplants and oral cancer drugs, which would be processed by the Durable Medical Equipment Regional Carrier (DMERC) in your area. Outpatient prescription drugs are covered under Medicare Part D and Medicare Advantage Plans.
  • Over-the-counter drugs.
  • Routine foot care.
  • Routine eye care including most eyeglasses and eye exams. (See information on National Eye Care Project below.)
  • Routine or yearly physical exams and screening tests except for preventive benefits listed above.
  • Shots or vaccinations except as named in preventive benefits above.
  • Acupuncture.
  • Experimental and Investigational Treatments, which are any treatments, procedures, facility, equipment, drugs, drug usage, devices or suppliers not generally recognized as accepted medical practice. They also include services or supplies requiring federal or other governmental agency approval that had not been granted at the time services were rendered.
  • Any chiropractic service including X-rays, except for treatment of subluxation of the spine.
  • Cosmetic surgery.


  • For a glossary of Medicare terms and their meaning, click here
  • Medicare Part A and Part B do not pay for drugs unless they are administered in a hospital or doctor's office. Drug coverage is covered under Medicare Part D. For information about Part D and what it covers, click here.  For information about how to maximize use of Part D, click here. 
  • For information about Medicare in general, click here
  • If you need an eye exam and are over age 65, are a U.S. citizen or legal resident, have not seen an opthalmologist in the past 3 years, and are not a member of an HMO insurance play,  National Eye Care Project is a nonprofit public service outreach program that provides eye exams and eye care for people age 65 and older through volunteer ophthalmologists nationwide.If a disease is diagnosed and requires ongoing care, treatment will be provided for one year. The following are not covered: Eyeglasses, prescriptions, hospital services and fees of other medical professionals.
    • How the program works: Within one week of contacting the Helpline, eligible callers will be mailed the name of a volunteer ophthalmologist in their area with instructions for making an appointment. 
    • To reach the helpline, call: 800.222.EYES (800.222.3937). Open 24 hours a day, 7 days a week.

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