What does Medicare cover?

by Contributing Author

Medicare is a health insurance program by the U.S. federal government that offers coverage to millions of Americans aged 65 and older and people under 65 with certain disabilities or life-threatening diseases. The Centers administer Medicare for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS). The program has several parts and each part covers different services.

Part A: Hospital Insurance

Medicare Part A is designed to cover inpatient hospital care, skilled nursing care, hospice care, and home health care. This coverage is available to people who have paid into the Medicare system through payroll taxes for not less than ten years. Part A range is typically free, but some coinsurance fees and deductibles exist.

Inpatient hospital care is covered under Part A and includes semi-private rooms, meals, nursing care, and medications. It also covers lab tests, X-rays, and other diagnostic tests necessary for the patient’s treatment. If a patient is hospitalized for over 60 days, coinsurance fees apply.

Skilled nursing care is also covered under Part A, but certain conditions must be met. The patient must have been hospitalized for at least three days before entering a skilled nursing facility, and the care must be deemed medically necessary. Medicare covers the first 20 days of care in a skilled nursing facility. After that, there is a coinsurance fee that applies.

Hospice care is covered under Part A for people who are terminally ill and have a life expectancy of six months or less. This coverage includes medical care, counseling, and medication for pain relief.

Part A also covers home services such as skilled nursing care, physical therapy, and occupational therapy. These services are covered if they are medically necessary and the patient is homebound.

Part B: Medical Insurance

Medicare Part B covers many medical services, including doctor visits, outpatient care, preventive care, and medical equipment and supplies. Part B coverage is optional, and beneficiaries pay a monthly premium.

Doctor visits are covered under Part B and include visits to primary care physicians, specialists, and other health care providers. Outpatient care, including diagnostic tests, lab work, and surgeries that do not require an overnight hospital stay, are also covered under Part B.

Preventive care is another important part of Part B coverage. This includes things like wellness visits, flu shots, and cancer screenings. Medicare covers the full cost of many preventive services, so beneficiaries need to take advantage of these services.

Part B also covers some medical equipment and supplies, such as wheelchairs, oxygen equipment, and diabetic supplies. However, certain rules apply to the coverage of these items.

Part C: Medicare Advantage Plans

Private insurance companies approved by Medicare offer Medicare Advantage plans. These plans offer every benefit offered by Parts A and B, as well as additional benefits such as prescription drug coverage and vision, dental, and hearing services. Medicare Advantage plans may also have cheaper out-of-pocket costs than Original Medicare.

In addition to the benefits of Parts A and B, Medicare Advantage plans may offer other benefits such as gym memberships, transportation to medical appointments, and wellness programs. These additional benefits can help seniors stay healthy and active, improving their overall quality of life.

One important thing to note is that beneficiaries must contribute to their Part B coverage in addition to any premium charged by their Medicare Advantage plan. Some Medicare Advantage plans may also have additional out-of-pocket costs, such as deductibles, copayments, and coinsurance fees.

Part D: Prescription Drug Coverage

Medicare Part D is prescription drug coverage available to everyone with Medicare. Private insurance companies approved by Medicare offers this coverage. Beneficiaries must contribute to monthly premiums for Part D coverage and a deductible and co-payments for each prescription.

Part D covers many prescription drugs, including brand-name and generic drugs. Beneficiaries must choose a Part D plan that covers the medications they need at a reasonable cost.

Medicare is a vital federal health insurance program that provides coverage to millions of Americans aged 65 and older and people under 65 with certain disabilities or end-stage renal disease. The program is divided into several parts, each of which covers different types of services, such as hospital care, medical services, prescription drug coverage, and more. By understanding the other parts of Medicare and its services, beneficiaries can make informed decisions about their health care and ensure they receive the care they need while minimizing their out-of-pocket costs. Beneficiaries need to take advantage of the benefits offered by Medicare as well as the changes to the program to ensure they receive the best care possible.