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The Medicare Handbook continued...

Types of Doctors

Most doctors' services are furnished by a doctor of medicine or a doctor of osteopathy. Other "physicians" that can furnish some covered services include chiropractors, doctors of podiatric medicine (podiatrists), doctors of dental surgery or of dental medicine (dentists), and doctors of optometry (optometrists).

Chiropractors' Services

Medicare helps pay for only one kind of treatment furnished by a licensed chiropractor: manual manipulation of the spine to correct a subluxation that is demonstrated by X-ray. Medicare Part B does not pay for any other diagnostic or therapeutic services, including Xrays, furnished by a chiropractor.

Podiatrists' Services

Medicare Part B helps pay for any covered services of a licensed podiatrist to treat injuries and diseases of the foot. Examples of common problems include ingrown toenails, hammer toe deformities, bunion deformities and heel spurs. Medicare generally does not pay for routine foot care such as cutting or removal of corns and calluses, trimming of nails, and other hygienic care. But, Medicare does help pay for some routine foot care if you are being treated by a medical doctor for a medical condition affecting your legs or feet (such as diabetes or peripheral vascular disease) which requires that the routine care be performed by a podiatrist or by a doctor of medicine or osteopathy.

Dentists' Services

Medicare Part B generally does not pay for care in connection with the treatment, filling, removal, or replacement of teeth; root canal therapy; surgery for impacted teeth; or other surgical procedures involving the teeth or structures directly supporting the teeth. However, Medicare does help pay for services of a dentist in certain cases when the medical problem is more extensive than the teeth or structures directly supporting them. (If you need to be hospitalized because of the severity of a dental procedure, Medicare Part A may pay for your inpatient hospital stay even if the dental care itself is not covered by Medicare.)

Optometrists' Services

Medicare helps pay for Medicare-covered vision care, including the services of an optometrist if the optometrist is legally authorized to perform those services by the state in which he or she performs them. However, Medicare will not pay for routine eye exams and usually will not pay for eyeglasses. (Medicare will pay for cataract spectacles, cataract contact lenses, or intraocular lenses that replace the natural lens of the eye after cataract surgery. Medicare will also pay for one pair of conventional eyeglasses or conventional contact lenses if necessary after cataract surgery with insertion of an intraocular lens.)

Second Opinion Before Surgery

Sometimes your doctor may recommend surgery for the treatment of a medical problem. In some cases, surgery is unavoidable. But there is increasing evidence that many conditions can be treated equally well without surgery. Because even minor surgery involves some risk, we recommend that you get an opinion from a second doctor to help you decide about surgery. Medicare will help pay for a second opinion. Medicare will also help pay for a third opinion if the first and second opinions contradict each other.

Your own doctor is the best source for referral to another doctor. But, if you wish, you can call your Medicare Part B carrier for the names and phone numbers of doctors in your area who provide second opinions.

Services of Special Practitioners

Medicare Part B helps pay for covered services you receive from certain specially qualified practitioners who are not physicians. The practitioners must be approved by Medicare. Medicare-approved practitioners are listed below:

  • Certified registered nurse anesthetist.
  • Certified nurse midwife.
  • Clinical psychologist.
  • Clinical social worker (other than in a hospital).
  • Physician assistant. (A physician assistant can furnish certain services in a hospital or certain other facilities, can serve as an assistant-at-surgery, and can furnish services in any location that is designated as a rural health professional shortage area.)
  • Nurse practitioner and clinical nurse specialist in collaboration with a physician. (A nurse practitioner can furnish services in a skilled nursing facility or a Medicaid nursing facility in any area. In addition, a nurse practitioner or clinical nurse specialist can furnish services in a rural area.)

Outpatient Hospital Services

Medicare Part B helps pay for covered services you receive as an outpatient from a participating hospital for diagnosis or treatment of an illness or injury. Under certain conditions, Medicare helps pay for emergency outpatient care you receive from a non-participating hospital.

When you get outpatient hospital services, you are responsible for the annual Medicare Part B deductible. In addition to the deductible, you are responsible for a coinsurance of 20 percent of the hospital's charge above the deductible.

When you go to a hospital for outpatient services, you are sometimes asked how much of your Part B deductible you have met. One easy way to answer that question is to show your most recent Explanation of Your Medicare Part B Benefits notice. From this form, hospital staff can usually tell how much of the $xxx annual deductible you have met. If the hospital cannot tell how much of the $xxx deductible you have met and the charge for the services you received is less than $xxx, the hospital may ask you to pay the entire bill. The amount you pay the hospital can be credited toward any part of the deductible you have not met. If you pay the hospital for deductible amounts you do not owe, the hospital or the Medicare intermediary will refund the amount you overpaid.

Major outpatient hospital services covered by Part B:

  • Services in an emergency room or outpatient clinic, including same-day surgery
  • Laboratory tests billed by the hospital.
  • Mental health care in a partial hospitalization psychiatric program, if a physician certifies that inpatient treatment would be required without it.
  • X-rays and other radiology services billed by the hospital.
  • Medical supplies such as splints and casts.
  • Drugs and biologicals that cannot be selfadministered.
  • Blood transfusions furnished to you as an outpatient.

Some outpatient hospital services not covered by Part B:

  • Routine physical examinations and tests directly related to such examinations.
  • Eye or ear examinations to prescribe or fit eyeglasses or hearing aids.
  • Immunizations (except pneumococcal pneumonia and hepatitis B vaccinations, or immunizations required because of an injury or immediate risk of infection).
  • Most routine foot care.