What Does Medicare Cover?
This article was updated on: 09/15/2018
If you’re wondering “what does Medicare cover?” we hope this article sums it up for you. We’ll talk about Medicare Part A, Part B, Part C, and Part D and what each part covers.
Here’s a quick overview of Medicare and what it covers. Original Medicare is the health insurance program created and administered by the federal government.
What does Medicare Part A (hospital insurance) cover?
Medicare Part A generally covers medically necessary services such as:
- Hospital inpatient care
- Skilled nursing facility
- Limited, medically necessary, home health care
- Hospice care.
What does Medicare Part B (medical insurance) cover?
Medicare Part B generally covers the following services:
- Most medically necessary doctor services
- Preventive services such as annual wellness exams and flu shots
- Hospital and clinic outpatient services
- Radiology (x-rays, CT scans and MRIs),
- Laboratory tests
- Outpatient mental health care
- Durable medical equipment
- Ambulance transportation
- Limited, usually temporary, home health care
What does Medicare Part C cover?
Before going into what Medicare Part C covers, here’s a quick rundown on what Part C is. Medicare Part C, commonly known as Medicare Advantage, provides an alternative way to receive your Original Medicare (Part A and Part B) coverage. Medicare Advantage plans are offered by private insurance companies that have contracts with Medicare. So, Medicare Advantage plans cover everything Original Medicare covers (excluding hospice care, which remains covered through Medicare Part A).
Many Medicare Advantage plans cover prescription drugs. They may include additional benefits, such as routine vision, hearing, and dental services. Not every Medicare Advantage plan covers prescription medications, but the ones that do are called Medicare Advantage Prescription Drug plans (sometimes abbreviated as MA-PDs). If you enroll in a Medicare Advantage plan, you still continue to pay your Medicare Part B premium. You may also have a Medicare Advantage plan premium to pay, depending upon the plan you select.
What does Medicare Part D cover?
Medicare Part D covers prescription drugs through private insurance companies contracted with Medicare. Medicare Part D prescription drug coverage is available not only from Medicare Advantage Prescription Drug plans (described above), but also from stand-alone Medicare Part D Prescription Drug Plans.
So, you could say that a Medicare Advantage Prescription Drug plan provides your Medicare Part A, Part B, and prescription drug coverage (Part D) a single plan.
If you decide to stay with Medicare Part A and Part B, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Medicare Supplement insurance is described below.
Each Medicare Prescription Drug Plan has a formulary, which is a list of prescription medications covered by that plan. Formularies include medications from all the therapeutic drug categories and typically include brand name and generic prescription drugs. Formularies and costs vary by plan, so it may be a good idea to compare the plans available where you live to identify the one that best meets your needs and includes your medications on its list of covered prescription drugs. Prescription drug formularies may change from time to time. You will be notified by the plan of changes to the formulary when necessary.
If you enroll in a Medicare Prescription Drug Plan, you may have to pay a monthly premium in addition to your Medicare Part B coverage.
What does Medicare Supplement plans cover?
You may be able to buy a Medicare Supplement (Medigap) plan to help pay for Medicare Part A and Part B out-of-pocket costs. Different Medicare Supplement plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Some plans may include services that Medicare doesn’t generally cover–such as emergency medical care outside the United States. Keep in mind, however, a Medicare Supplement plan does not work with a Medicare Advantage plan, nor do Medicare Supplement plans sold today cover prescription drugs.
What does Medicare not cover?
While Medicare covers many medical services, it doesn’t cover everything. You may be surprised to learn that Original Medicare (Part A and Part B) doesn’t cover long-term care when the focus is on daily living activities (custodial care) rather than skilled care. Here are some examples of services and items Original Medicare doesn’t typically cover:
- Routine dental care
- Routine foot care
- Hearing aids and exams for fitting them
- Vision exams related to prescribing eye glasses or contact lenses
- Most prescription drugs (except some medications administered in the hospital or during outpatient chemotherapy treatments)
Some Medicare Advantage plans may cover the benefits listed above.
I am happy to help you if you would like to learn more about your Medicare coverage options. You can schedule a telephone appointment or have information provided by email using the link below. You can also explore the Medicare plan options available where you live by clicking on the Find Plans or Compare Plans buttons on this page and typing in your zip code.