|
June 11, 2008 |
|
2008-R-0326 |
|
Proposed and Enacted Mandated Insurance Benefits in connecticut and medicare benefits |
||
|
|
||
|
By: Janet L. Kaminski Leduc, Senior Legislative Attorney |
||
You asked for a list of (1) mandated health insurance benefits that the legislature proposed and enacted in 2007 and 2008, (2) benefits Connecticut law requires health insurance policies to include, and (3) what Medicare covers.
summary
In Connecticut, health insurance laws are contained in Chapter 700c of the general statutes. Due to federal preemption, state insurance mandates generally do not apply to self-insured plans. (For more information, see OLR Research Report 2005-R-0753, Self-Insurance Benefit Plans and Insurance Mandates.)
The tables below include the following information:
· Table 1 - health insurance mandates proposed, but not enacted, in 2007;
· Table 2 - health insurance mandates enacted in 2007;
· Table 3 - health insurance mandates proposed, but not enacted, in 2008;
· Table 4 - health insurance mandates enacted in 2008;
· Table 5 - mandated policy benefits;
· Table 6 - health care providers whose services must be covered; and
· Table 7 - health care facilities whose services must be covered.
Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicare has several parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plan – an alternative to “original” Medicare), and Part D (Medicare prescription drug plan).
This report focuses on “original” Medicare (Parts A and B). Medicare Part A helps cover inpatient care in hospitals (critical access hospitals and inpatient rehabilitation facilities), skilled nursing facilities after a hospital stay, religious nonmedical health care institutions, home health care services, and hospice care. Medicare doesn’t cover custodial or long-term care. Medicare Part B helps cover medically-necessary services like doctors’ services, outpatient care, and other medical services that Part A doesn’t cover.
Table 8 below includes more details on what Medicare Parts A and B cover. More information is available in the federal government publication regarding Medicare, which may be viewed online at: http://www.medicare.gov/Publications/Pubs/pdf/10116.pdf.
proposed and enacted health insurance mandates
Table 1: Health Insurance Mandates: 2007 Proposed But Not Enacted
|
Bill |
Title |
Description |
|
SB 55 |
An Act Requiring Health Insurance Coverage For Medical Supplies For Persons With Lymphedema |
To require coverage for compression bandages, garments, and supplies for people with lymphedema. |
|
SB 67 |
An Act Expanding Health Insurance Coverage For Dependent, Unmarried Children |
To require individual health insurance policies and group comprehensive health care plans to provide that coverage of a dependent, unmarried child terminates when the child turns age 24, regardless of student status. |
|
SB 73 |
An Act Expanding Insurance Coverage For Hearing Aids For Children |
To require coverage for hearing aids as durable medical equipment for children under age 19, instead of 13. |
|
SB 164 |
An Act Requiring Heath Insurance Coverage For Emergency Medical Conditions |
To require coverage for the treatment of emergency medical conditions. |
|
SB 165 |
An Act Requiring Heath Insurance Coverage For Colonoscopies For Colon Cancer Survivors |
To require full coverage for colonoscopies for colon cancer survivors. |
|
SB 166 |
An Act Increasing Insurance Coverage For Hearing Aids For Children |
To require coverage for hearing aids for children age 18 or younger and permit the policy to limit the benefit to $2,500 per ear in a 36-month period. |
Table 1: -Continued-
Table 1: -Continued-
Table 2: Health Insurance Mandates: 2007 Enacted
|
Public Act |
Title |
Description |
|
07-67 (sSB 389) |
An Act Concerning Hospitalization At An Out-Of-Network Facility During Treatment In Cancer Clinical Trials |
Provides that coverage for cancer clinical trials includes treatment at an out-of-network facility if (1) it is unavailable at an in-network facility and (2) the clinical trial sponsors are not paying for it. The out-of-network hospital treatment must be available at no greater cost to the patient than if treatment was available at an in-network facility. |
|
07-75 (sHB 7055) |
Requires insurers, HMOs, and other entities to include a specified definition of “medically necessary” or “medical necessity” in health insurance policies. |
|
|
07-113 (sSB 1214) |
An Act Concerning Postclaims Underwriting |
Removes from the preexisting condition definition for individual health insurance policies a physical or mental condition that manifested itself during the 12 months before coverage became effective. Thus, it defines a preexisting condition as a physical or mental condition for which medical advice, diagnosis, care, or treatment was recommended or received during the 12 months before coverage became effective. Imposes preexisting condition exclusion limitations on short-term policies. |
|
07-185 (SB 1484) |
An Act Concerning The Healthfirst Connecticut And Healthy Kids Initiatives
|
Raises, from age 23 to 26, the age to which group comprehensive and individual health insurance policies that cover children must do so. The act eliminates the requirements that children be dependent or full-time students and limits the continuing coverage to those who live in Connecticut. |
|
07-197 (SB 66) |
An Act Expanding Insurance Coverage For Specialized Formulas For Children |
Requires coverage for medically necessary specialized formulas administered under a physician's direction for children up to age 12. Prior law was until age eight. |
|
07-252 (sHB 7163) |
An Act Concerning Revisions To Statutes Relating To The Departments Of Public Health And Social Services And Town Clerks |
Changes the name of critical access hospitals to mobile field hospitals. By law, health insurance policies must provide coverage for such hospitals. |
|
07-2, JSS (HB 8002) |
An Act Implementing The Provisions Of The Budget Concerning Human Services And Public Health |
Amends PA 07-185 with respect to insurance coverage for children by extending coverage to children who attend accredited out-of-state colleges or who live in another state with a custodial parent. Requires coverage for blood lead screening and risk assessments primary care providers order pursuant to § 48 of the act. |
Table 3: Health Insurance Mandates: 2008 Proposed But Not Enacted
Table 4: Health Insurance Mandates: 2008 Enacted
connecticut’s health insurance mandates
Table 5: Connecticut Health Insurance Mandates: Required Benefits
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-476(b)(1) |
Preexisting Condition Coverage |
Group |
May not impose preexisting condition exclusion beyond 12 months after effective date of coverage, and exclusion may only relate to conditions for which medical advice, diagnosis, care, or treatment was recommended or received six months before the policy’s effective date. |
|
38a-476(b)(2) |
Preexisting Condition Coverage |
Individual, except for short-term policy |
May not impose preexisting condition exclusion beyond 12 months after effective date of coverage, and exclusion may only relate to conditions for which medical advice, diagnosis, care, or treatment was recommended or received 12 months before the policy’s effective date. |
|
38a-476(g) |
Preexisting Condition Coverage |
Individual short-term policy |
May not impose preexisting condition exclusion beyond 12 months after effective date of coverage, and exclusion may only relate to conditions for which medical advice, diagnosis, care, or treatment was recommended or received 24 months before the policy’s effective date. |
|
38a-476b |
Availability of Psychotropic Drugs |
Both |
No mental health care benefit provided under state law, or with state funds or to state employees may limit the availability of the most effective psychotropic drugs. |
|
38a-482a 38a-513c |
Medically Necessary Definition |
Both |
Specifies the definition of “medically necessary” that policies must include. |
|
38a-483c 38a-513b |
Experimental Treatments |
Both |
Procedures, treatments, or drugs that have completed a Phase III FDA clinical trial. Appeals process expedited for those with a life expectancy of less than two years. |
|
38a-488a 38a-514 |
Mental Illness Parity |
Both
|
Diagnosis and treatment of mental or nervous conditions. Coverage cannot differ from the terms, conditions, or benefits for the diagnosis or treatment of medical, surgical, or other physical health conditions. |
Table 5:-Continued-
|
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-488a |
Residential Treatment Facilities |
Individual |
Benefits for residential treatment facility for a person with a serious mental illness are payable when the person has been confined in a hospital for such illness for at least three days immediately preceding confinement in the residential treatment facility and the illness would otherwise necessitate continued hospital confinement if such care and treatment were not available through a residential treatment center for children and adolescents. |
|
38a-514
(PA 08-125) |
Residential Treatment Facilities |
Group |
Effective January 1, 2009:
Benefits for residential treatment facility for a person with a serious mental of nervous condition are payable when a physician, psychiatrist, psychologist, or clinical social worker assesses the person and determines that he or she cannot appropriately, safely, or effectively be treated in other settings. |
|
38a-489 38a-515 |
Mentally or Physically Handicapped Dependent Children |
Both |
After passing dependent status and coverage would otherwise end, coverage must continue if child is both mentally or physically handicapped and dependent upon insured for support. |
|
38a-490 38a-508 38a-516 38a-549 |
Newborns and Adopted Children |
Both |
Injury and sickness, including care and treatment of congenital defects and birth abnormalities, for newborns from birth and for adopted children from legal placement for adoption. |
|
38a-490a 38a-516a |
Birth-to-Three |
Both |
At least $3,200 per child annually for medically necessary early invention services, up to $9,600 per child over three years. |
|
38a-490b 38a-516b |
Hearing Aids for Children |
Both |
Hearing aids for children 12 and under. Coverage may be limited to $1,000 within a 24-month period. |
|
38a-490c 38a-516c |
Craniofacial Disorders |
Both |
Medically necessary orthodontic processes and appliances for treatment of craniofacial disorders for people under age 18. Coverage is not required for cosmetic surgery. |
Table 5: -Continued-
|
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-492l 38a-516d
|
Children with Cancer |
Both |
Coverage for children diagnosed with cancer after December 31, 1999 for neuropsychological testing a physician orders to assess the extent chemotherapy or radiation treatment has caused the child to have cognitive or developmental delays. Insurers cannot require pre-authorization for the tests. |
|
38a-491a 38a-517a |
Anesthesia for Dental Services |
Both |
Medically necessary general anesthesia, nursing, and related hospital services for in-patient, outpatient, or one-day dental services. |
|
38a-492 38a-518 |
Accidental Ingestion or Consumption of Controlled Drugs |
Both |
Emergency medical care for the accidental ingestion or consumption of controlled drugs. Coverage is subject to a minimum of 30 days inpatient care and a maximum $500 for outpatient care per calendar year. |
|
38a-492a 38a-518a |
Hypodermic Needles and Syringes |
Both |
Hypodermic needles and syringes prescribed by a prescribing practitioner for administering medications. |
|
38a-492b 38a-518b |
Off-Label Cancer Drugs |
Both |
If a prescription drug is recognized for treatment of a specific type of cancer, a policy cannot exclude coverage of the drug when it is used for another type of cancer. |
|
38a-492c 38a-518c
|
Protein Modified Food and Specialized Formula |
Both |
Amino acid modified and low protein modified food products when prescribed for the treatment of inherited metabolic diseases and cystic fibrosis. Medically necessary specialized formula for children up to age 12. Food and formula must be administered under the direction of a physician. Coverage for preparations, food products, and formulas must be on the same basis as coverage outpatient prescription drugs. |
|
38a-492d 38a-518d |
Diabetes |
Both |
Laboratory and diagnostic tests for all types of diabetes. Medically necessary equipment, drugs, and supplies for insulin-dependent, insulin using, gestational, and non-insulin using diabetes. |
|
38a-492e 38a-518e |
Diabetes Self-Management Training |
Both |
Outpatient self-management training prescribed by a licensed health care professional. Coverage is subject to the same terms and conditions as other policy benefits. |
Table 5:-Continued-
|
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-492f 38a-518f |
Prescription Drugs Removed from Formulary |
Both |
A prescription drug that has been removed from the list of covered drugs must be continued if the insured was previously using the drug for the treatment of a chronic illness and it is deemed medically necessary. |
|
38a-492g 38a-518g |
Prostate Screening |
Both |
Laboratory and diagnostic tests to screen for prostate cancer for men who are symptomatic, have a family history, or are over 50. |
|
38a-492h 38a-518h |
Lyme Disease Treatment |
Both |
Lyme disease treatment including not less that 30 days of intravenous antibiotic therapy, 60 days of oral antibiotic therapy, or both, and further treatment if recommended by a rheumatologist, infectious disease specialist, or neurologist. |
|
38a-492i 38a-518i |
Pain Management |
Both |
Access to a pain management specialist and coverage for pain treatment ordered by such specialist. |
|
38a-492j 38a-518j |
Ostomy Appliances and Supplies |
Both |
If policy covers ostomy surgery, policy must also cover up to $1000 per year for medically necessary ostomy-related appliances and supplies. |
|
38a-492k 38a-518k |
Colorectal Cancer Screening |
Both |
Colorectal cancer screening. Frequency of screening to be based on recommendations by the American College of Gastroenterology. |
|
38a-493 38a-520 |
Home Health Care |
Both |
Home health care including (1) part-time or intermittent nursing care and home health aide services; (2) physical, occupational, or speech therapy; (3) medical supplies, drugs and medicines; and (4) medical social services. Coverage can be limited to no less than 80 visits per year and, for a terminally ill person, no more than $200 for medical social services. Coverage can be subject to an annual deductible of no more than $50 and a coinsurance of no less than 75%, except that a high deductible plan used to establish a medical savings account is exempt from the deductible limit. |
Table 5: -Continued-
|
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-523 |
Comprehensive Rehabilitation Services |
Group |
Group health insurance must offer coverage for comprehensive rehabilitation services, including (1) physician services, physical and occupational therapy, nursing care, psychological and audiological services, and speech therapy; (2) social services provided by a social worker; (3) respiratory therapy; (4) prescription drugs and medicines; (5) prosthetic and orthotic devices and; (6) other supplies and services prescribed by a doctor. |
|
38a-496 38a-524 |
Occupational Therapy |
Both |
If policy covers physical therapy, it must provide coverage for occupational therapy. |
|
38a-482 38a-497 38a-554 |
Dependent Children |
Both |
Until January 1, 2009:
Unmarried, dependent child under age 19, or age 23 if a full-time student at an accredited school. |
|
38a-482 38a-497
(PA 08-147, § 8) |
Children |
Individual |
Effective January 1, 2009:
Coverage continues until the policy's anniversary date on or after the date the child marries; ends his or her Connecticut residency, unless he or she is (a) under age 19 or (b) a full-time student at an accredited school of higher education; becomes covered under a group health plan through his or her employment; or attains age 26. |
|
38a-554
(PA 08-147, § 9) |
Children |
Group |
Unmarried child under age 26. Must offer continuation coverage to the end of the month in which the child marries; ends his or her Connecticut residency, unless he or she is (a) under age 19 or (b) a full-time student at an accredited school of higher education; becomes covered under a group health plan through his or her employment; or attains age 26. |
|
38a-498 38a-525 |
Ambulance Services |
Both |
Ambulance service when medically necessary. Payment must be on a direct pay basis where notice of assignment is reflected on the bill. |
|
38a-498a 38a-525a |
911 Calls |
Both |
Cannot require preauthorization for 911 calls. |
Table 5: -Continued-
|
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-498b 38a-525b
|
Mobile Field Hospitals |
Both |
Benefits for isolation care and emergency services provided by mobile field hospitals, previously called critical access hospitals. Such benefits are subject to any policy provisions that apply to other covered services. The rates a policy pays must be equal to the rates Medicaid pays, as determined by the Department of Social Services. |
|
38a-498c 38a-525c |
Injured and Under the Influence |
Both |
Insurance polices prohibited from denying coverage for health care services rendered to an injured insured person if the injury is alleged to have occurred or occurs when the person has an elevated blood alcohol level (0.08% or more) or is under the influence of drugs or alcohol. |
|
38a-501
|
Long-Term Care Policy – Non-Forfeiture |
Individual |
Prohibits an insurer from issuing or delivering a long-term care policy on or after July 1, 2008 unless it had offered the prospective insured an optional non-forfeiture benefit during the policy solicitation or application process. If the non-forfeiture option is declined, the insurer must give the insured a contingent benefit upon lapse. |
|
38a-501
|
Long-Term Care Policy – Elimination Period |
Individual |
Changes the elimination period required under a long-term care insurance policy. Prior law required a “reasonable” elimination period (i.e., a waiting period after the onset of the injury, illness, or function loss during which no benefits are payable). The act instead requires an elimination period that is (1) up to 100 days of confinement or (2) between 100 days and two years of confinement if an irrevocable trust is in place that is estimated to be sufficient to cover the person's confinement costs during this period. Sets requirements for the trust. |
|
38a-502 38a-529 |
Veteran’s Home and Hospital |
Both |
Cannot exclude coverage for services provided by the Veteran’s Home and Hospital. |
Table 5: -Continued-
|
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-503 38a-530 |
Mammography and Breast Cancer Screening |
Both |
Baseline mammogram for woman 35 to 39 and one every year for woman 40 and older. Additional coverage must be provided for a comprehensive ultrasound screening of a woman’s entire breast(s) if (1) a mammogram shows heterogeneous or dense breast tissue based on BI-RADS or (2) she is at increased breast cancer risk because of family history, her prior history, genetic testing, or other indications determined by her physician or advanced-practice nurse. Coverage is subject to any policy provisions applicable to other covered services. |
|
38a-503b 38a-530b |
Obstetrician-Gynecologist; Pap Smear |
Both |
Direct access to participating in-network ob-gyn for gynecological examination, care related to pregnancy, and primary and preventive obstetric and gynecologic services required as result of a gynecological examination or condition (includes pap smear). Female enrollees may also designate participating ob-gyn or other doctor as primary care provider. |
|
38a-503c 38a-530c |
Maternity Care |
Both |
Minimum 48-hour hospital stay for mother and newborn after vaginal delivery and minimum 96-hour hospital stay after caesarian delivery. |
|
38a-503d 38a-530d |
Mastectomy |
Both |
Minimum 48-hour hospital stay after mastectomy or lymph node dissection or longer stay if recommended by physician. |
|
38a-503e 38a-530e |
Contraceptives |
Both |
If prescription drugs are covered, then prescription contraceptives must be covered. An employer or individual may decline contraceptive coverage if it conflicts with religious beliefs. |
|
38a-533 |
Treatment of Alcoholism |
Group |
Expenses incurred in connection with medical complications of alcoholism such as cirrhosis of the liver, gastrointestinal bleeding, pneumonia, and delirium tremens. |
|
38a-507 38a-534 |
Chiropractic Services |
Both |
Cover chiropractor services to same extent as coverage for a physician. |
|
38a-535 |
Preventive Pediatric Care |
Group |
Preventive pediatric care at the following intervals (1) every 2 months from birth to 6 months, (2) every 3 months from 9 to 18 months, and (3) annually from 2 to 6 years of age. Coverage is subject to any policy provisions that apply to other services covered under the policy. |
Table 5: -Continued-
|
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-535
|
Lead Screening |
Both |
Effective January 1, 2009:
Coverage for blood lead screening and risk assessments ordered by primary care providers in accordance with § 48 of PA 07-2, JSS. |
|
38a-509 38a-536 |
Infertility |
Both |
Medically necessary costs of diagnosing and treating infertility. |
|
38a-542(a)&(b) |
Breast Implant Removal |
Group |
Medically necessary removal of breast implants implanted on or before July 1, 1994. Annual coverage must be at least $1,000 for removal of any such breast implant. |
|
38a-504(a)&(b) 38a-542(a)&(b) |
Treatment for Leukemia, Tumors, and Wigs for Chemotherapy Patients |
Both |
Surgical removal of tumors an treatment of leukemia, including outpatient chemotherapy, reconstructive surgery, non-dental prosthesis, surgical removal of breasts due to tumors, and a wig if prescribed by a licensed oncologist for a patient suffering hair loss due to chemotherapy. Annual coverage must be at least $500 for surgical tumor removal, $500 for reconstructive surgery, $500 for outpatient chemotherapy, $350 for a wig, and $300 for prosthesis, except for surgical removal of breasts due to tumors, the prosthesis benefit must be at least $300 for each breast removed. |
|
38a-504(c) 38a-542(c) |
Breast Reconstruction after Mastectomy |
Both |
Reconstructive surgery on non-diseased breast for symmetrical appearance. Coverage is subject to the same terms and conditions as other benefits under the policy. |
|
38a-504a – 38a-504g; 38a-542a – 38a-542g
|
Cancer Clinical Trials |
Both |
Routine patient costs relating to cancer clinical trials. Out-of-network hospitalization paid as in-network benefit if services are not available in-network. Such trials must have peer-reviewed protocols approved by one of several federal organizations. |
Table 5: -Continued-
|
CGS § |
Mandate |
Applicable to Group Policy, Individual Policy, or Both |
Description |
|
38a-511 38a-550 |
Copays for Imaging Services (MRIs, CAT scans, and PET scans) |
Both |
Limits copays for MRIs and CAT scans to no more than (1) $375 for all such services annually and (2) $75 for each one. Limits copays for PET scans to no more than (1) $400 for all such scans annually and (2) $100 for each one. Limits not applicable if (1) the ordering physician performs the service or is in the same practice group as the one who does and (2) to high deductible health plans designed to compatible with federally qualified Health Savings Accounts. |
|
PA 08-132 |
Autism Spectrum Disorder Therapies |
Both |
Effective January 1, 2009:
Requires coverage for physical, speech, and occupational therapy services for the treatment of autism spectrum disorders to the extent such services are a covered benefit for other diseases and conditions under the policy. |
Table 6: Connecticut Health Insurance Mandates: Covered Providers
|
CGS § |
Provider |
|
38a-488a 38a-514 |
· Licensed physician · Licensed psychiatrist · Licensed psychologist · Licensed clinical social worker · Independent social worker certified before October 1, 1990 · Licensed marital and family therapist · Marital and family therapist certified before October 1, 1992 · Licensed alcohol and drug counselor · Certified alcohol and drug counselor · Licensed professional counselor |
|
38a-491 38a-517 |
· Licensed dentist |
|
38a-492i 38a-518i |
· Pain management specialist
(i.e., a physician credentialed by the American Academy of Pain Management or who is a board-certified anesthesiologist, neurologist, oncologist, or radiation oncologist with additional training in pain management) |
|
38a-496 38a-524 |
· Licensed occupational therapist |
|
38a-499 38a-526
|
· Licensed physician assistant · Certified nurse practitioner · Certified psychiatric-mental health clinical nurse specialist · Certified nurse mid-wife |
Table 6: -Continued-
|
CGS § |
Provider |
|
38a-503b 38a-530b
|
· Obstetrician-gynecologist · Nurse mid-wife · Advanced practice nurse |
|
38a-507 38a-534 |
· Licensed chiropractor
|
|
38a-523 |
Comprehensive rehabilitation services provided by:
· Physician · Physical therapist · Occupational therapist · Nurse · Psychologist · Audiologist · Speech therapist · Social workers · Respiratory therapist
(Optional group health insurance benefit insurer must offer.) |
|
38a-553
|
· Physician · Registered nurse · Social worker · Licensed physical therapist |
Table 7: Connecticut Health Insurance Mandates: Covered Facilities
|
CGS § |
Facility |
|
38a-488a 38a-514 |
· Licensed hospital or clinic · Child guidance clinic · Residential treatment facility · Nonprofit community mental health center · Nonprofit licensed adult psychiatric clinic |
|
38a-498b 38a-525b |
· State mobile field hospital (formerly known as critical access hospitals) |
|
38a-502 38a-529 |
· State Veterans’ Home
|
|
38a-523 |
· Comprehensive rehabilitation facility (Optional group health insurance benefit insurer must offer. |
|
38a-553
|
· Hospital · Skilled nursing facility · Licensed alcohol treatment facility |
medicare parts a and b
Table 8 shows many of the services Medicare covers. Coverage may be subject to certain conditions and limitations, including patient copayments and coinsurance. For more information regarding these conditions and limitations, refer to the enclosed federal government publication regarding Medicare, which may be viewed online at: http://www.medicare.gov/Publications/Pubs/pdf/10116.pdf.
Table 8: What “Original” Medicare Covers
|
Preventive Services (Part B coverage): |
|
Abdominal aortic aneuryism screening |
|
Bone mass measurement |
|
Cardiovascular screening |
|
Colorectal cancer screening |
|
Diabetes screening |
|
Diabetes self-management training |
|
Flu shot |
|
Glaucoma tests |
|
Hepatitis B shot |
|
Mammograms |
|
Medical nutrition therapy services |
|
Pap test/pelvic exam (cancer screening) |
|
Physical exam (one “Welcome to Medicare” exam only) |
|
Pneumococcal shot |
|
Prostate cancer screening |
|
Smoking cessation counseling |
|
Part A (Hospital Insurance): |
|
Anesthesia |
|
Blood |
|
Chemotherapy |
|
Clinical research study costs |
|
Defibrillator (implantable automatic) |
|
Dental services (not routine care) |
|
Dialysis (kidney) treatment |
|
Home health services |
|
Hospice care |
|
Hospital care |
|
Mental health and substance abuse care |
|
Radiation therapy |
|
Religious nonmedical health care institution |
|
Respite care |
|
Skilled nursing facility care |
|
Transplants (facility charges) |
Part B (Medical Insurance): |
|
Ambulance services |
|
Ambulatory surgical centers |
|
Anesthesia |
|
Blood |
|
Breast reconstruction and protheses after mastectomy (including post-surgical brassiere) |
|
Canes/crutches |
Table 8: -Continued-
|
Part B (Medical Insurance): |
|
Cardiac rehabilitation |
|
Chemotherapy |
|
Chiropractic services |
|
Clinical research study costs |
|
Commode chairs |
|
Defibrillator (implantable automatic) |
|
Diabetes supplies and services |
|
Diagnostic tests, X-rays, and clinical laboratory services |
|
Dialysis services and supplies |
|
Doctor’s services |
|
Durable medical equipment |
|
Emergency room services |
|
Foot care and podiatrist services (not routine care) |
|
Home health services |
|
Hospital services (outpatient) |
|
Laboratory services |
|
Macular degeneration treatment |
|
Mental health and substance abuse care |
|
Orthotics (artificial limbs and eyes and arm, leg, back, and neck braces) |
|
Ostomy supplies |
|
Oxygen therapy |
|
Physical and occupational therapy |
|
Speech-language pathology services |
|
Practitioner services (clinical social workers, physician assistants, and nurse practitioner) |
|
Prescription drugs (limited benefit) |
|
Preventive services (see above) |
|
Radiation therapy |
|
Rural health clinic and federally-qualified health center services |
|
Second surgical opinions |
|
Surgical dressing services |
|
Telemedicine (rural areas) |
|
Transplants (doctor services) |
JLK:ts