Oregon Certified Nursing Assistant State Practice Exam

What will Medicare pay for?

1. All care requested by the recipient

2. All care requested by the doctor

3. All care requested by the long-term care facility

4. Only care that it determines to be medically necessary

The correct answer is: Only care that it determines to be medically necessary

Medicare provides coverage primarily for services that are deemed medically necessary to treat specific health conditions. This means that only those services that a qualified healthcare provider, typically a doctor, determines are essential for the patient's health will be covered. The focus of Medicare is on ensuring that its resources are allocated effectively to support patient care that is appropriate and supported by clinical evidence. For example, while a physician might recommend a wide range of treatments or services, Medicare reviews these recommendations and will only pay for those that align with its guidelines regarding medical necessity. Services that may be beneficial but do not meet the criteria for necessity—such as purely elective procedures or items not linked to a diagnosis—would not be covered. This policy ensures that Medicare funds are used wisely and efficiently, serving to balance patient needs with the sustainability of the program.