What Does Medicare Cover?

Confusion about what your Medicare plan covers can keep you from getting the care you need and cost you in the end. Few things can impact your life or retirement like health conditions, especially if you don’t have coverage for prescription drugs, equipment and treatments.

The foundation of Medicare is Part A and Part B. The federal government administers Parts A and B through Original Medicare. If you choose a Medicare Advantage plan (Part C), a private insurance company administers Parts A and B, and extra benefits like hearing, vision, dental and more. Part D plans cover prescription drugs. Once you are enrolled in Part A and Part B, you can choose Original Medicare or a Medicare Advantage plan based on your health needs.

Medicare is a federal public health insurance program that provides coverage across the United States. The services covered, and paid for, by Medicare are determined in multiple ways. In some cases, federal and state laws determine coverage and costs. Medicare can make decisions about coverage at the national level. At the local level, carriers that administer Medicare coverage can make decisions to cover a product or not, based on whether it’s medically necessary.

When it comes to paying for services, Medicare will cover most but not all of your costs after you reach your deductible. Medicare pays 80% of approved costs and you pay 20% of approved costs. You can get additional help with out-of-pocket costs if your Medicare coverage is eligible to add a Medicare Supplement plan.

For most people preparing to enroll in Medicare, the first question is about Part A or Part B coverage. Keep reading for a coverage breakdown of both parts.

If you’re new to Medicare, it’s essential to understand the four parts of Medicare. All four parts of Medicare do not work together in a single Medicare plan. After you are enrolled in Part A and Part B, you have options to enroll in Part C and Part D. Keep reading to learn more about these options.

What does Medicare Part A cover?

Medicare Part A covers most of your inpatient services and a few others. It’s easy to think about Part A as hospital coverage. In general, Medicare Part A will cover most but not all of your costs after you’ve reached your deductible amount. Here are typical services covered by Part A,

• Inpatient care in a hospital, for example, surgery

• Skilled nursing facility care

• Nursing home care, as long as it’s not custodial or long-term care.

• Hospice care

• Home health care

What does Medicare Part B cover?

Medicare Part B covers most of your outpatient services. If you think about Part A as hospital coverage, think about Part B as your medical coverage. Your most common doctor visits and preventive services will be mostly covered by Medicare Part B. In addition to diagnosis and treatment, Part B covers things like durable medical equipment. Here are typical services covered by Part B,

• Medically necessary services (required for diagnosis or treatment)

• Preventive services (services to prevent or detect illness in early stages)

• Ambulance services

• Durable medical equipment

• Mental health

What does Medicare Part C cover?

Medicare Part C refers to Medicare Advantage plans. Medicare pays private insurance carriers to administer these plans, which offer the same benefits as Original Medicare Parts A and B. However, most Medicare Advantage plans include additional benefits like dental, hearing, vision and prescription drug coverage.

Medicare Advantage plans are not standardized like Original Medicare. Depending on where you live, you can have several different plans available. Even though each plan is a Medicare Advantage plan, each plan can vary based on costs and the benefits it provides.

When you enroll in Medicare Part C, your plan is required to provide all the same benefits of Part A and Part B, but your Part C benefit ID card takes the place of your Medicare red, white and blue card at every visit.

What does Medicare Part D cover?

If you take daily prescription drugs for your health, you should consider Medicare’s prescription drug coverage (Part D). If you have Original Medicare, prescription drug coverage is limited without adding a Part D plan. In most cases, Original Medicare beneficiaries choose to add a Part D prescription drug plan. Of course, you have Part D options with Medicare Advantage, too.

If you choose to enroll in a Medicare Advantage plan, it’s likely that you can get a plan that includes Part D coverage. Most Medicare Advantage plans include Part D and other benefits like vision, dental, and hearing benefits not included in Original Medicare.

Either way, be sure to review your options with Medicare Part D. Although you may have more than one Part D plan available, each plan varies. Make sure the plan you choose covers your prescription drugs.

Medicare coverage is going to meet most of your health care needs. However, there are services and items that are not covered by Medicare. If you have Original Medicare, every type of care you need or may want is not going to be covered. You may choose to add Medicare supplement insurance to help with some costs that Medicare doesn’t pay.

After you enroll in Part A and Part B, you may consider a Medicare Advantage plan. Medicare Advantage plans can provide coverage for dental, vision, hearing, and Medicare Part D.  These plans are private insurance, so each plan can vary from another. Make sure that you compare Medicare Advantage plan options before enrolling.

Whether you enroll in Original Medicare or a Medicare Advantage plan, Part A and Part B coverage is the same when it comes to what Medicare does not cover.

Beyond coverages and benefits, it’s important to know the commonalities and differences between your Medicare plan options. We’ve compiled a quick list for you to understand them.