Merck Manual

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Who Pays for What?

Who Pays for What?

Type of Care

Services

Covered by

Hospital care*

Inpatient care, including mental health care

General nursing and other hospital services and supplies

Drugs used during hospitalization

A semiprivate room (a private room only if medically necessary)

Meals

Medicare Part A

Medicare Part C (Medicare Advantage)

Medicaid

Department of Veterans Affairs (VA)†

Short-term care in a certified skilled nursing facility (nursing home)

Skilled nursing care

Social services

Drugs used in the facility

Medical supplies and equipment used in the facility

Dietary counseling

Physical, occupational, and speech therapy (if needed) to meet the person's health goals

Transportation by ambulance (when other transportation endangers health) to the nearest facility providing needed services unavailable at the skilled nursing facility

A semiprivate room

Meals

Medicare Part A if people need short-term care temporarily after a hospital stay

Medicare Part C if people need short-term care temporarily after a hospital stay

Medicaid

VA†

Outpatient care

Doctor’s, nurse practitioner’s, and physician assistant’s fees, including for certain telehealth services (real-time remote office visits and consultations) 

Emergency department visits

Transportation by ambulance (when other transportation endangers health)

Outpatient surgery (with no overnight stay in the hospital)

Rehabilitation (physical, occupational, and speech therapy)

Diagnostic tests, such as x-rays and laboratory tests

Outpatient mental health care

Outpatient dialysis

A second opinion if surgery is recommended and a third opinion if opinions differ

For people with diabetes, diabetes supplies, self-management training, eye examinations, and nutrition counseling

Smoking cessation

Durable medical equipment, such as wheelchairs, hospital beds, oxygen, and walkers

Medicare Part B

Medicare Part C

Medicaid

VA†

Home health care

Personal care, including help with eating, bathing, going to the bathroom, dressing

Part-time skilled nursing care

Physical, occupational, and speech therapy

Home health aide services

Social services

Medical supplies, such as wound dressings, but not prescription drugs

Medicare Part A if people are homebound and need part-time skilled nursing care or rehabilitation on a daily basis

Medicare Part B

Medicare Part C

Medicaid

VA†

Preventive care

Screening tests for breast, cervical, colorectal, lung, prostate, and vaginal cancer

Screening tests for abdominal aortic aneurysm, depression, hepatitis B and C, HIV, elevated cholesterol 

Screening and counseling for alcohol misuse, cardiovascular disease, diabetes, obesity, sexually transmitted infections, tobacco use

Bone density measurements

Glaucoma tests

Influenza, pneumococcal, and hepatitis B vaccinations

One-time Welcome-to-Medicare preventive visit

Yearly wellness visit (includes voluntary advance care directive preparation)

Nutrition therapy services

Medicare Part B

Medicare Part C

Medicaid

VA†

Extra benefits

Prescription drugs

Eyeglasses

Hearing aids

Medicare Part C

Medicare Part D (prescription drug plans)

Medicare Part B (limited outpatient prescription drugs)

Medicaid in some states

VA†

Long-term care in an assisted living community

Varies greatly from community to community

Meals

Help with daily activities

Some social and recreational activities

Some health care

Medicaid in a few states (partial coverage)

VA† in some situations

Long-term care in a skilled nursing facility (nursing home)

Varies from state to state

Medicaid

VA†

Hospice care

Physical care and counseling

Room and meals only during inpatient respite care and short-term hospital stays

Medicare Part A

Medicare Part C

* Medicare Part A covers care in long-term care hospitals for people who may have more than one serious condition and be expected to improve and return home.

† For the Veterans Administration (VA), the rules of eligibility vary for different services and change frequently.