Medicare Coverage Criteria

Medicare, the U.S. health insurance program for senior citizens, has four different parts. Only Part A is mandatory if you want to participate in Medicare, but all parts have their own benefits. They also have a host of their own costs, so the more Medicare parts you have, the more you pay, although you also gain assistance with more services. Medicare does not indiscriminately cover every medical need a user could want, however. All services must meet different official Medicare criteria before being approved for payment.

Hospice

• Medicare Part A features a hospice benefit. Hospice offers care for a terminally ill person, concentrating on making the patient pain-free and comfortable in her last days. Treatment of the condition is not part of hospice care, which is generally performed in the patient's home. Home health, skilled nursing, respite care, doctor's visits and prescriptions are included in the Part A hospice benefit. In order for Medicare to cover hospice services, however, they must come from an approved hospice provider. The patient's doctor must also certify that the patient is in the last six months of a fatal disease. The patient herself must also state in writing that she chooses hospice care over aggressive medical treatment.

Alternative Therapies

• Some Medicare users prefer to use alternative forms of treatment and preventive services such as holistic medicine, biofeedback, aromatherapy and acupuncture. Beneficiaries are free to choose these kinds of services if they desire, but Medicare will not cover them. The patient must pay 100 percent of the costs themselves.

Mental Health Care

• Original Medicare Parts A and B offer coverage for inpatient and outpatient mental health services. Outpatient services are covered by Part B and require a 50 percent copay for the service and a separate copay for the facility. Inpatient mental health services are covered by Part A and must be provided by a general hospital or a psychiatric hospital. In 2011, you must pay an initial deductible of $952 for the first 60 days or treatment, and then a copay of $238 per day for stays of 61 to 90 days. The copay goes up to $476 per day for stays of 91 through 150 days, after which Medicare pays nothing. You are also only allowed 190 days of inpatient mental health care during your lifetime.

Nursing Home Care

• Basically speaking, Medicare does not cover nursing home care. Medicare has no benefits specifically for custodial or long-term nursing home or skilled nursing facility services. Under certain circumstances, patients can receive a limited amount of nursing facility care, though. The Part A hospice benefit includes coverage for up to five days in a row of respite care in a nursing facility, with no limits on how many respite periods a hospice patient may take. Skilled nursing facility care may be covered under Part A for patients who had a qualifying three-day inpatient hospital stay. A patient can still have Medicare-covered hospital days remaining that haven't been taken.