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Hospital
Insurance (Part A)
Hospital Stays. Semi-private room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in critical access hospitals and mental health care. This doesn’t include private duty nursing, or a television or telephone in your room. It also doesn’t include a private room, unless medically necessary.
Inpatient mental health care in a
psychiatric facility is limited to 190 days in a lifetime.
Skilled Nursing Facility Care. Semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day inpatient hospital stay).
Home Health Care.
Part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.
Hospice Care. For people with a terminal illness, includes drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare. Hospice care is usually given in your home. However, Medicare covers some short-term hospital and inpatient respite care (care given to a hospice patient so that the usual caregiver can rest).
Blood. Pints of blood you get at a hospital or skilled nursing facility during a covered stay.
Medical Insurance (Part
B)
Medical and Other Services. Doctors’ services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, and outpatient occupational and physical therapy including speech-language therapy. (These services are also covered for long-term nursing home residents.)
Clinical Laboratory Services. Blood tests, urinalysis, some screening tests and more.
Home Health Care. Part-time or intermittent skilled nursing care and home health aide services, physical therapy, occupational therapy, speech-language therapy, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen and walkers), medical supplies, and other services.
Outpatient Hospital Services. Hospital services and supplies received as an outpatient as part of a doctor’s care.
Blood. Pints of blood you get as an outpatient or as part of a Part B covered service.
Preventive Services. Bone mass measurements, colorectal cancer screening, diabetes services, glaucoma testing, screening mammograms, Pap test and pelvic examination (includes a clinical breast exam), prostate cancer screening, and shots (Flu, Pneumococcal Pneumonia, and Hepatitis B). (In 2005, preventive benefits coverage will expand as described
in "What's New In Medicare?")
What is not paid for by the
Original Medicare Plan?
The Original Medicare Plan doesn’t cover everything. Items and services that aren’t covered by Part A or Part B include, but aren’t limited to:
- acupuncture;
- deductibles, coinsurance, or copayments when you get health care services;
- dental care and dentures (with only a few exceptions);
- cosmetic surgery;
- custodial care (help with bathing, dressing, using the bathroom, and eating) at home or in a nursing home;
- health care you get while traveling outside of the United States (except in limited cases);
- hearing aids and hearing exams not ordered by your
doctor, or for the purpose of fitting a hearing aid;
- long-term care, such as custodial care in a nursing home;
- orthopedic shoes (with only a few exceptions);
- outpatient prescription drugs (with only a few exceptions);
- routine foot care (with only a few exceptions);
- routine eye care and most eye glasses;
- routine or yearly physical exams;
- screening tests (except those
listed under "What
Medicare Covers - Medical Insurance Part B");
- shots (except Flu, Pneumococcal
Pneumonia, and Hepatitis B);
- some diabetic supplies (like syringes or insulin unless used with an insulin pump);
- virtual colonoscopies.
Medical Insurance Claims
Palmetto GBA, a subsidiary of Blue Cross and Blue Shield of South Carolina, processes medical insurance (Part B) claims for railroad retirement beneficiaries in the Original Medicare Plan. If you are in the Original Medicare Plan, your hospital, doctor, or other health care provider should submit Part B claims directly to:
Palmetto GBA
Railroad Medicare Part B Office
P.O. Box 10066
Augusta, GA 30999-0001
If you have questions about Part B claims under
the Original Medicare Plan, write to Palmetto GBA at the
above address; telephone them toll-free at 1-800-833-4455,
(TTY/TDD: 1-877-566-3572); or go to www.palmettogba.com on
the Internet, click on “Railroad Medicare” under “Beneficiaries,” and
select “Contact Us.”
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