What Does Medicare Cover?

Key Takeaways

• Medicare Part A and Part B (Original Medicare) cover most hospital and medical services. If you have Original Medicare, it does not cover vision, dental and hearing.

• Medicare covers essential health services and preventive care, including hospital stays, provider visits and limited outpatient prescription drugs.

• Medicare Part D provides prescription drug coverage. With Original Medicare, Part D must be added. Most Medicare Advantage plans include Part D in the plan.

• Medicare does not cover your costs in total. After you reach your plan’s deductible, Medicare pays 80% of approved costs and you are responsible for 20% of the costs.

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  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.

  

How Does Medicare Coverage Work?

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.

Need a Medicare Service or Item, But Not Sure How It’s Covered?

If you are enrolled in Medicare, you have great health insurance with plenty of benefits. Still, looking out for your health and your budget means knowing that a common, or less common, service is covered.

Our interactive coverage tool helps you quickly find the answer to “is it covered?” Getting started is simple. Click on the type of coverage or benefit below and choose your service from the list. We provide you with what you need to know.

Keep reading if you want to learn more about coverage and the different parts of Medicare.

The Four Parts of Medicare: What’s Covered and What’s Not Between Parts A, B, C, and D?

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.

What Is Not Covered by Medicare?

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.

This website is operated by Derene Derricotte, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.