What Does Medicare Cover?
Last Updated : 06/20/20196 min read
If you will soon be eligible for Medicare, you may be wondering, “What does Medicare cover?” The good news is that Medicare provides broad health-care coverage. Also, the Medicare program gives you the flexibility to choose how you get your Medicare coverage.
Here’s a quick rundown of the “parts” of Medicare, and the choices you may have about your Medicare coverage.
Medicare Part A and Part B make up Original Medicare. Many people are automatically enrolled in Part A and Part B. You may be automatically enrolled if you’re receiving Social Security retirement or disability benefits when you qualify for Medicare.
What does Medicare cover under Part A?
Under Medicare Part A, hospital care as well as some nursing home, rehabilitation, mental health, and hospice care are generally covered. However, you may have to meet certain qualifications.
- Inpatient hospital care. Medicare Part A covers general nursing services, a semi-private room, meals, medical supplies, and certain medications.
- Skilled nursing facility care. Medicare covers room, board, and a range of skilled nursing services provided in a skilled nursing facility. This may include certain medications, tube feedings, and wound care, among other approved services. To qualify, you must have spent at least three consecutive days as a hospital inpatient within 30 days of admission to the skilled nursing facility and need skilled nursing or therapy services.
- Home health care. Medicare might cover limited services in your home if you qualify (for example, you’re homebound, need skilled care, and under a doctor’s care). Medicare covers up to 100 days of part-time daily care or intermittent care if medically necessary. You must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care. If you don’t qualify for home health care coverage under Part A, you might have Medicare coverage under Part B.
- Mental health care. Medicare Part A may cover your mental health care services as a hospital inpatient. This can be a general hospital or a psychiatric hospital.
- Hospice care. This is care you may choose if your doctor determines you are terminally ill, expected to live six months or less. Generally, Medicare covers hospice care for as long as your provider certifies that you need it.
Usually Medicare Part A doesn’t pay the full cost of your hospital-related care. You will likely have to pay your share of the Medicare-approved amount for services Medicare covers. The portions you pay are deductibles and coinsurance or copayments. Also, there are time limits – after a certain amount of time as an inpatient within one year, you may have to pay all costs. Learn more about Medicare costs.
What does Medicare cover under Part B?
Medicare coverage under Part B helps pay for medical and outpatient services. Common health care services that Medicare covers may include:
- Medically necessary services you receive from a doctor or other licensed health professional. This includes some preventive care services, such as annual wellness exams, flu shots, and screens to help detect certain forms of cancer.
- Durable medical equipment such as walkers, wheelchairs, and oxygen tanks. This is medical equipment your doctor certifies you need that you use repeatedly and typically at home. You generally rent or purchase durable medical equipment from a Medicare-certified supplier.
- Diagnostic tests such as lab work and x-rays.
- Ambulance services, usually in an emergency situation where ambulance transportation is medically necessary.
- Therapies such as speech, physical, and occupational you receive from a Medicare-certified therapist.
- Certain medications, usually given in a doctor’s office or clinic. These may include anti-cancer medications, immunosuppressant drugs, or other medications you generally wouldn’t take on your own at home. Part B may also cover as well as certain vaccines.
Generally, Medicare Part B pays 80% of the Medicare-approved amount for covered services after you pay your annual Part B deductible. Some services don’t cost you anything (like flu shots). You typically pay a monthly Part B premium, as well.
What does Medicare cover under Part C?
Medicare Part C is the Medicare Advantage program. It’s not something you automatically get from the government. With Medicare Advantage, you have the option to receive your Medicare coverage from a private insurance company contracted with Medicare.
Medicare Advantage plans must offer you at least the same level of Medicare coverage as Part A and Part B. Frequently, Medicare Advantage plans combine Medicare coverage for prescription drugs along with medical benefits.
Some Medicare Advantage plans offer additional benefits to standard Medicare coverage. For example, Medicare Advantage plans may provide benefits for routine dental and/or vision care.
You’ll continue paying your Medicare Part B premium when you have a Medicare Advantage plan – as well as any premium the plan charges. Medicare Advantage plans typically charge cost-sharing amounts, like copayments or coinsurance. Plans may have annual deductibles.
What does Medicare cover under Part D?
Medicare covers prescription drugs under Part D. It’s optional, but if you take prescription drugs, you might want to sign up for this Medicare coverage. Private companies offer Medicare prescription drug coverage as either of these plan types:
- As a stand-alone Medicare Part D prescription drug plan, for those enrolled in Medicare Part A and/or Part B
- As part of a Medicare Advantage Prescription Drug plan
As with other Medicare coverage, you may need to pay coinsurance or copayments – and possibly monthly premiums and annual deductibles. Read out more about Medicare prescription drug coverage.
Can you expand your Medicare coverage with a Medicare Supplement insurance plan?
Your Medicare coverage generally comes with cost-sharing, as you read above. A Medicare Supplement insurance plan may pay some or all of the out-of-pocket costs of Medicare Part A and Part B.
These out-of-pocket costs may include deductibles, copayments, and coinsurance. Some Medicare Supplement insurance plans even cover emergency medical care during overseas travel (up to 80%).
Private insurance companies sell Medicare Supplement insurance plans. All Medicare Supplement insurance plans must provide basic benefits, such as Medicare Part A and Part B coinsurance amounts, blood, and additional hospital benefits not covered by Medicare Part A. Read more about Medicare Supplement insurance.
As you’ve seen, you may have several Medicare coverage options. To compare plans, type your zip code in the box on this page and press the button.
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