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Medicare Program
Doctor’s Services

Medicare Part B covers medically-necessary services or covered preventive services you get from your doctor in his or her office, in a hospital, in a skilled nursing facility, in your home, or any other location.

Medicare doesn’t cover routine physicals, except the one-time “Welcome to Medicare” physical exam. See page 29. Medicare covers some preventive tests and screenings. See Preventive Services.

In 2010, YOU pay 20% of the Medicare-approved amount.
 
Dialysis (Kidney) Services and Supplies

Medicare covers some kidney dialysis services and supplies for people with End-Stage Renal Disease (ESRD).

Inpatient dialysis treatments: Medicare Part A covers dialysis if you’re admitted to the hospital for special care. See Hospital Care (Inpatient).

Outpatient maintenance dialysis treatments: Medicare Part B covers dialysis if you need regular treatments, and you get treatments in any Medicare-approved dialysis facility.


In 2010, YOU pay 20% of the Medicare-approved amount.


Certain home dialysis support services: Medicare Part B covers visits by trained dialysis workers to check on your home dialysis, to help in dialysis emergencies when needed, and to check your dialysis equipment and hemodialysis water supply.


In 2010, YOU pay 20% of the Medicare-approved amount. Only dialysis facilities can furnish home dialysis support services.


Certain drugs for home dialysis: Medicare Part B covers heparin, the antidote for heparin when medically necessary, and topical anesthetics.


In 2010, YOU pay 20% of the Medicare-approved amount, if you deal with a supplier. If you deal with the dialysis facility, these drugs are included in the cost of dialysis.


Erythropoiesis–stimulating Agents: Medicare covers agents like Epogen®, Epoetin alfa, Aranesp®, or Darbepoetinalfa to treat anemia if you have End-Stage Renal Disease.


In 2010, YOU pay 20% of the Medicare-approved amount.

Self-dialysis training: Medicare Part B covers training for you and the person helping you with your home dialysis treatments.

In 2010, YOU pay 20% of the Medicare-approved amount.


Home dialysis equipment and supplies: Medicare Part B covers equipment and supplies like alcohol, wipes, sterile drapes, rubber gloves, and scissors.


In 2010, YOU pay 20% of the Medicare-approved amount. If you deal with a dialysis facility, the cost of home dialysis equipment and supplies is included in the cost of dialysis. If you deal with a medical supply company, it (not the dialysis facility) must accept assignment.
 
Diagnostic Tests, X-rays, and Clinical Laboratory Services

Medicare Part B covers diagnostic tests like CT scans, MRIs, EKGs, and X-rays when your doctor or health care provider orders them as part of treating a medical problem. Medicare also covers clinical diagnostic laboratory services provided by certified laboratories enrolled in Medicare. Diagnostic tests and lab services are done to help your doctor diagnose or rule out a suspected illness or condition. Medicare doesn’t cover most routine screening tests, like checking your hearing. Medicare covers some preventive tests and screenings to help prevent, find, or manage a medical problem. For more information, see Preventive Services.


In 2010, YOU pay 20% of the Medicare-approved amount for covered diagnostic tests and X-rays done in a doctor’s office or independent testing facility. You pay a copayment for diagnostic tests and X-rays in the hospital outpatient setting. You pay $0 for Medicare-covered lab services.
 
Diabetes Supplies and Services

Medicare Part B covers some diabetes supplies, including the following:

•    Blood sugar (glucose) test strips  
•    Blood sugar monitor
•    Lancet devices and lancets
•    Glucose control solutions for checking test strip and monitor accuracy

There may be limits on how much or how often you get these supplies. For more information, see Durable Medical Equipment on page 17.


In 2010, YOU pay 20% of the Medicare-approved amount.


Insulin: Medicare Part B doesn’t cover insulin (unless used with an insulin pump), insulin pens, syringes, needles, alcohol swabs, or gauze. Insulin and certain medical supplies used to inject insulin, such as syringes, gauze, and alcohol swabs may be covered under Part D. If you use an external insulin pump, insulin and the pump may be covered as durable medical equipment. See Durable Medical Equipment (DME).

In 2010, YOU pay 100% for insulin unless used with an insulin pump (then you pay 20% of the Medicare-approved amount) and 100% for syringes and needles, unless you have Part D.

 

Therapeutic Shoes or Inserts: Medicare Part B covers therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease. The doctor who treats your diabetes must certify your need for therapeutic shoes or inserts. The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist. Medicare helps pay for one pair of therapeutic shoes and inserts per calendar year. Shoe modifications may be substituted for inserts. Medicare covers the fitting of the shoes or inserts for the shoes.


In 2010, YOU pay 20% of the Medicare-approved amount. Medicare covers these diabetes services:


Diabetes Self-Management Training: Medicare Part B covers diabetes outpatient self-management training to teach you to manage your diabetes. It includes education about how you monitor your blood sugar, diet, exercise, and insulin. If you’ve been diagnosed with diabetes, Medicare may cover up to 10 hours of initial diabetes self-management training. You may also qualify for up to 2 hours of follow-up training each year if the following conditions are met:

• It’s provided in a group of 2 to 20 people.*
• It lasts for at least 30 minutes.
• It takes place in a calendar year after the year you got your initial training.
• Your doctor or a qualified provider ordered it as part of your plan of care.

* Some exceptions apply if no group session is available or if your doctor or qualified provider says you have special needs that prevent you from participating in group training.

In 2010, YOU pay 20% of the Medicare-approved amount.

Yearly Eye Exam: Medicare Part B covers a yearly eye exam for diabetic retinopathy by an eye doctor who is legally allowed by the state to do the test.


In 2010, YOU pay 20% of the Medicare-approved amount for the doctor’s services. In a hospital outpatient setting, you pay a copayment.

Foot Exam: Medicare Part B covers a foot exam every 6 months for people with diabetic peripheral neuropathy and loss of protective sensations, as long as you haven’t seen a foot care professional for another reason between visits.


In 2010, YOU pay 20% of the Medicare-approved amount for the doctor’s services. In a hospital outpatient setting, you pay a copayment.
 
Diabetes Screenings

Medicare Part B covers tests to check for diabetes. These tests are available if you have any of the following risk factors: high blood pressure, dyslipidemia (history of abnormal cholesterol and triglyceride levels), obesity, or a history of high blood sugar. Medicare also covers these tests if two or more of the following apply to you:

•    Age 65 or older
•    Overweight
•    Family history of diabetes (parents, brothers, sisters)
•    A history of gestational diabetes (diabetes during pregnancy) or delivery of a baby weighing more than 9 pounds

Based on the results of these tests, you may be eligible for up to two diabetes screenings every year.


In 2010, YOU pay $0 for this test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.