Your Medicare Coverage
Is my test, item, or service covered?
Outpatient hospital services
How often is it covered?
Medicare Part B (Medical Insurance) covers medically necessary diagnostic and treatment services you get as an outpatient from a Medicare-participating hospital. Covered outpatient hospital services may include:
- Emergency or observation services, which may include an overnight stay in the hospital
- Services in an outpatient clinic, including same-day surgery
- Laboratory tests billed by the hospital
- Mental health care in a partial hospitalization program, if a doctor certifies that inpatient treatment would be required without it
- X-rays and other radiology services billed by the hospital
- Medical supplies, like splints and casts
- Preventive and screening services
- Certain drugs and biologicals that you wouldn’t usually give yourself
All people with Medicare are covered.
Your costs in Original Medicare
- You generally pay 20% of the Medicare-approved amount for the doctor or other health care provider's services, and the Part B deductible applies.
- For all other services, you also generally pay a copayment for each service you get in an outpatient hospital setting. You may pay more for services you get in a hospital outpatient setting than you would pay for the same care in a doctor's office.
- For some screenings and preventive services, coinsurance, copayments, and the Part B deductible don't apply (so you pay nothing).
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.