Medicare 101: What Services Does Medicare Cover?

Medicare is a great resource for a wide range of healthcare coverage. Unlike Medicaid, which is income-based, Medicare provides health insurance coverage for anyone who is age 65 or older, or who has a severe disability, no matter what their income is.

However, choosing a Medicare plan can be confusing. Medicare is broken into four parts: Part A, Part B, Part C and Part D. Each plan covers different benefits, and there are certain services that Medicare doesn’t cover at all.

You can only change your Medicare coverage once per year, so it’s important to choose the right plans for the services you need. This article explains what is and isn’t covered by Medicare and can help you choose the right plans for you.

Original Medicare

This plan is the most common form of Medicare coverage, and it is directly issued by the US government. There are two parts to Original Medicare: Part A and Part B. Each part covers different types of healthcare services.

Part A: Hospital Insurance

The first part of Original Medicare typically covers inpatient hospital stays, stays in a skilled nursing facility, hospice care, and some home health services. As with other types of insurance, there are limitations, deductibles and co-insurance or other out-of-pocket costs.  Part A is available without a premium for people who have worked and paid Social Security taxes for at least 10 years. If you have not worked and paid taxes for 10 years, there will be a monthly premium.

If you or your loved one is considering assisted living or a nursing home, keep in mind that custodial services such as help with day-to-day tasks are not covered by Medicare.

Part B: Medical Insurance

Most medically necessary equipment, doctors’ services, mental healthcare, hospital outpatient services, some therapy and preventative care are covered by Part B. It may also cover some home health and ambulance services. A monthly premium is required to receive Part B. As with other types of insurance, there are limitations, deductibles and co-insurance or other out-of-pocket costs. 

Private Medicare

Unlike Original Medicare, Part C and Part D Medicare plans are provided by private insurance companies that have contracts with the US government. Part C is an alternative to Part A and Part B.

Part C: Medicare Advantage

The plans offered under Part C are also known as Medicare Advantage plans. They are Medicare-approved private insurance plans for people who have Original Medicare. A Medicare Advantage Plan provides coverage similar to Medicare Part A and Part B. It also can offer other services that aren’t covered by Original Medicare, such as dental, vision and hearing.

A Medicare Advantage Plan can sometimes be less expensive than the out-of-pocket costs you pay under Original Medicare, depending on your needs, but there may be some limitations or restrictions. The Medicare Advantage plan will set the premiums, the deductibles, the copayments and any coinsurance amounts.

Part D: Outpatient Prescription Drug Insurance

Medicare Part D is an optional part of Medicare that covers prescription drugs.

If you decide to get Part D, you’ll need to choose a plan that works with your Medicare existing benefits. Many Medicare Advantage plans offer Part D coverage. If you have Original Medicare only, you can choose a stand-alone Part D plan.

What Original Medicare Doesn’t Cover

Additional Costs with Part A and Part B:

Deductibles

• Part A has a $1,316 deductible for inpatient hospital stays.
• Part B has a $183 deductible per year.      

Coinsurance payments

• Not including the deductible, inpatient hospital stays longer than 60 days have additional coinsurance payments and after 90 days you will be responsible for all costs.

Part B copayments

• After the deductible is met, Medicare usually covers 80 percent of services and you are responsible for 20 percent.

Parts A and B typically do not cover the following:

• Non-skilled Long-term care such as nursing homes or assisted living
• Personal care (help with daily tasks)
• Most dental services
• Eye exams for prescription glasses purposes
• X-rays
• Dentures
• Cosmetic surgery
• Hearing aids and exams related to them
• Routine foot care
• Alternative medicine such as chiropractic services, acupuncture, etc.
• Overseas coverage
• Non-emergency services

If you’re still not sure whether the service you need is covered by Medicare, use this tool to find out.

Have Questions?

Medicare can be confusing, especially when you’re looking into long-term care for yourself or a loved one. For more information on Medicare and paying for senior living costs, call us to learn more.

Sources:

Medicare.gov

Medicareinteractive.org

Healthline.com