What Does Medicare Cover?

iHealthcareApril 25, 2021

Medicare is a federal health insurance program designed to cover medical costs for citizens or legal residents that are 65 years old or older. Some people who are under 65 can also enroll in the program if they meet certain qualifications. 

Medicare consists of various parts. Part A and Part B are known as Original Medicare, while Part C is known as Medicare Advantage. There is also Medicare Part D and Medicare Supplements.

Medicare Part A

Medicare Part A, which is part of what is known as Original Medicare, provides coverage for inpatient hospital services. Beneficiaries who are admitted to a hospital based on a doctor’s order will get coverage for certain hospital costs.

Under Part A, you’ll also get coverage for skilled nursing facility care, hospice care, and some home healthcare services. For beneficiaries who have paid the necessary Medicare taxes while employed, there will also be no premium for Part A.

Medicare Part B

Part B is the second part of Original Medicare. Under Part B, Medicare beneficiaries get coverage for outpatient healthcare services such as preventive screenings, doctor visits, durable medical equipment, and more. Many Medicare enrollees enroll in Part A and Part B to get more coverage for their healthcare expenses. 

In some cases, Part B will also cover certain prescriptions, like immunosuppressants or anticancer drugs.

Medicare Advantage

Medicare Advantage is also called Medicare Part C and covers the same services as Parts A and B. It covers inpatient and outpatient procedures and services like doctor visits, preventive screenings, hospice care, medical equipment, and other medical expenses. 

Most Medicare Advantage plans also include coverage for prescription drugs and extra benefits such as routine hearing, dental, vision, and more. However, to enroll in Medicare Advantage, you must be enrolled in Original Medicare. Also, you must continue to pay your Part B premiums, though some Part C plans may not even have a premium.

Medicare Part D

Medicare Part D provides coverage for at least two drugs in each class or category. These plans are also required to cover most, if not all drugs listed in these specific categories:

  • Anticonvulsants
  • Antipsychotics
  • Anticancer
  • Antidepressants
  • Immunosuppressants
  • HIV/AIDS drugs

Medicare Supplement Plans

Medicare Supplements, also known as Medigap, help to cover the out-of-pocket expenses that Original Medicare does not cover. While each Medigap plan provides different coverage, here is a general idea of what could be covered:

  • Coinsurance
  • Copayments
  • Deductibles
  • Excess charges
  • Foreign travel emergency care
  • Blood transfusions

What Does Medicare Not Cover?

While Medicare does cover quite a bit of services, there are some services that Medicare does not cover, such as acupuncture, cosmetic procedures and medications, and long-term care. This is why it is important to understand what each part covers before you enroll.

To learn more about what each part of Medicare covers and what your options are, reach out to us today by giving us a call at 713-900-1901.

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