What Does Medicare Cover?
Medicare is the United States’ federal healthcare program that covers all people over age 65, certain people younger than age 65 who are disabled and people who have permanent kidney failure. Medicare coverage has four different components, called “parts,” and each part pays for different medical services and other benefits. If you’re approaching age 65 or have another condition that may make you eligible for Medicare coverage, it’s important to understand what the different parts do — and don’t — provide.
Medicare Part A covers services related to hospitalization and inpatient care. If a doctor admits you into a hospital for treatment, this care is covered for 90 days per benefit period. The benefit period “resets” once you’ve been out of the hospital for 60 days or longer. Medicare-covered services that you can receive in the hospital include your stay in a semi-private room, meals, general nursing care that you receive from the staff, drugs involved in your treatment and other necessary services and supplies the hospital may provide. This portion of Medicare also covers time you spend receiving care in a psychiatric hospital.
If you need care in a skilled nursing facility for rehabilitation, Medicare Part A covers 100 days each benefit period. Hospice care for terminal illnesses and home health care are also covered. Overall, this part of Medicare covers care you receive in acute-care hospitals, critical-access hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term care hospitals and hospital stays that you undergo while participating in a qualifying clinical research study.
Medicare Part B covers outpatient medical care like doctor appointments and other medically necessary services you receive from a licensed healthcare practitioner. These services include preventive health screenings; physical, speech and occupational therapies; X-rays and lab tests; mental health care, such as treatment programs for substance use; and other similar services. Although it sounds like Part A might cover the physician services you receive while in the hospital, Part B is actually what pays for this care. Emergency transportation in an ambulance is also covered under Part B, as are some prescriptions and durable medical equipment (DME) devices such as wheelchairs.
Part B covers two different types of services you receive from a healthcare practitioner. Medically necessary services are those that allow a doctor to diagnose or treat a health condition you have. This portion of Medicare also covers preventative services. This is any care you receive that’s aimed at preventing illnesses or detecting them at an earlier stage when treatment is more likely to be effective. This type of care also involves health screenings. The official website for Medicare maintains a list of preventative services that are covered.
Medicare Part C doesn’t cover specific devices or types of medical care. It’s a different form of Medicare that allows you to receive Medicare coverage through a private plan instead of directly from the U.S. federal government. Medicare you receive directly from the government is called Original Medicare. These private plans are called Medicare Advantage plans, and they still provide Part A and Part B coverage. However, they require you to use in-network physicians and facilities — similar to some traditional health insurance plans — instead of having the option to choose any doctor, clinic or other facility that accepts Medicare.
When you first enroll in Medicare, you can choose whether you want Original Medicare or a Part C plan. If you want to switch to a Part C plan from Original Medicare or vice versa, you can do so during certain periods of time throughout the year. The monthly premiums for Part B Medicare and a Part C plan are typically the same, but some Part C plans may offer dental, vision and hearing coverage at an extra cost.
This part of Medicare covers prescription drugs. It’s an optional benefit, meaning you can enroll in it through Medicare or continue to use another form of insurance you have that already pays for prescriptions, such as coverage through the Department of Veterans Affairs or Tricare. Part D covers a wide variety of medications, but it’s important to review a plan’s formulary, which is a list of covered prescriptions, to ensure you can get the medicine you need without paying for it out of pocket.
If you choose Original Medicare when you sign up, you’ll need to enroll in Part D separately if you want prescription drug coverage. Many Medicare Advantage plans under Part C offer their own prescription drug coverage. If you opt for an Advantage plan that has this coverage, you’ll likely need to get it through your plan and not through Original Medicare.
What Medicare Doesn’t Cover
Medicare often doesn’t pay the full cost of services and care you receive. It’s a wise idea to purchase a separate insurance plan to eliminate the gap in what Medicare pays versus the remaining amounts on medical bills you’ll owe for services.
Medicare also doesn’t cover most dental care, dentures, eye exams, hearing aids and cosmetic surgeries. It doesn’t provide coverage for certain forms of alternative treatments and therapies, such as acupuncture. Long-term care, which assists people who need help performing activities of daily living like dressing and bathing, also isn’t covered under Medicare. You’ll need to purchase separate long-term care insurance to pay for these services if you anticipate needing them later in life.