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What does Medicare cover?

Whether you’ve signed up for Original Medicare or still have sales letters stacked in your mailbox, you might have a few questions about your coverage options — because many times, it might not be totally clear what it is you’re signing up for.


Medicare is uniquely divided into the following parts: Parts A, B, C, and D. There’s Original Medicare (Parts A and B), Medicare Advantage (Part C), and Medicare Part D (prescription drug coverage). There’s also Medigap (or Medicare Supplement). This might be different than what you’re used to with your previous health insurance plan and can make things a little confusing at first. (Though you have options if you’d prefer that type of coverage again!)


But think of the different Parts of Medicare like building blocks, which can be put together based on your unique needs and budget. Ahead, we’re going to break down each part and discuss what’s covered, what’s not, and who’s covering it (is it the government, or a private insurance company?). Keep reading to learn more — and if you’re still not feeling clear, Licensed Medicare Advisors are just a phone call away.


The different Parts of Medicare and what they cover


Medicare Part A


Medicare Part A is hospital insurance. These benefits cover hospital charges and most of the services you’d receive when you’re in the hospital. They include services such as:


  • A semi-private room
  • Hospital meals
  • Skilled nursing services
  • Care on special units (like intensive care)
  • Drugs, medical supplies, and medical equipment used during your hospital stay
  • Lab tests and X-rays needed during your hospital stay
  • Operating room and recovery room services
  • Some blood transfusions in a hospital or skilled nursing facility
  • Rehabilitation services (including physical therapy received through home health care)
  • Skilled home health care (if you’re homebound and only need part-time care)
  • Care to manage symptoms and pain for the terminally ill (hospice care)

To enroll in Medicare Part A, you’ll need to do so directly through the government — and in many cases, you won’t have to pay a monthly premium. To be eligible for premium-free Part A, you or your spouse must have paid enough Medicare tax for a sufficient period of time as determined by Social Security (or the Railroad Retirement Board, if you were a railroad worker).


Medicare Part B


Medicare Part B is medical insurance. These benefits include certain doctors’ services, outpatient care, labs, medical supplies, and preventive services, such as:


  • Doctor visits (including an annual wellness or physical)
  • Ambulatory surgery center services
  • Outpatient medical services
  • Some preventive care (like flu shots and certain tests and screenings)
  • Clinical laboratory services (like blood and urine tests)
  • X-rays, MRIs, CT scans, EKGs, and other diagnostic tests
  • Medical equipment for home use (like wheelchairs and walkers)
  • Emergency room services
  • Skilled nursing care and health aide services (for part-time or intermittent homebound patients)
  • Outpatient mental health care
  • Physical therapy
  • Chemotherapy
  • Diabetes screenings, supplies, and self-management therapy
  • Alcohol use counseling

Medicare Part B requires a monthly premium (which will depend on what your income was while you were working), making it voluntary coverage. And like Medicare Part A, you’ll need to enroll directly through the government.


What’s not covered by Part A and Part B?


Medicare Parts A and Part B (known together as Original Medicare) don’t cover everything, including:


  • Custodial (non-medical) care
  • Most dental care
  • Eye exams (for prescribing glasses)
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

If you’d like coverage for these services, it might be a good idea to look into a Medicare Advantage plan, also known as Medicare Part C.


Medicare Part C (or Medicare Advantage)


Medicare Advantage is privatized, all-in-one health insurance. These plans are very similar to the health insurance you probably had in the past, with additional benefits like dental care, vision care, over-the-counter items, and other specialized health and wellness needs.


Premiums for Medicare Advantage plans vary (and often as low as $0!). You’ll still have to have Medicare Parts A and B to enroll in this type of coverage, though.


You can enroll in a Medicare Advantage plan through a private insurance company. There are only three requirements:


  • You must already have Medicare Parts A and B.
  • You have checked to make sure you live in the Medicare Advantage plan’s service area.
  • You do not have end-stage renal disease.

Medicare Part D


Medicare Part D is prescription drug coverage. These benefits include your prescription drugs, which are not covered by Parts A and B.


Each Medicare prescription drug plan is different — some drugs may be covered on one plan, while others might not. When comparing Part D coverage, check each plan’s drug list to make sure your drugs are included. Or, give a KindHealth Licensed Medicare Advisor a call for free expertise — they can help you compare plans and premiums over the phone, so you don’t have to stress.


If you think you’ll need prescription drug coverage at any point, consider enrolling in a Part D plan or a Medicare Advantage plan with prescription drug coverage upon initial Medicare eligibility, or your Initial Enrollment Period. (Learn more about when that is here.) You are liable for penalties (which are added to your Part D drug premiums) based on how many months you went without this type of coverage since turning 65.


Medigap (or Medicare Supplement)


Medigap is extra health coverage you can buy from a private company to pay for Medicare costs that are not covered by Parts A and B, like:


  • Medicare Part A and B deductibles
  • Coinsurance and providers’ excess charges
  • Additional hospital days after you’ve used up your Part A benefits
  • Some preventive care benefits
  • Blood transfusions

These Medicare benefits are designed to help fill the “gaps” in Original Medicare, since an Original Medicare plan covers most — but not all — healthcare costs. Some policies even cover medical care when you travel outside of the U.S., as long as it is a type of care covered by Original Medicare.


Since these Medicare supplement plans are offered through private insurance companies, pricing can vary. Also, you’ll need to be enrolled in Original Medicare in order to enroll in this type of supplemental coverage.


While it might seem overwhelming at first, one of the best things about Medicare is how customizable it can be. Prefer all-in-one care and supplemental benefits? A Medicare Advantage plan is probably right up your alley. Or if you like the flexibility of a large doctor network, Medicare Parts A and B (with the option to add Medigap and Part D, if you want) could be the better option.


But if you’re still not sure what you think you need, KindHealth can help. In partnership with Kasasa Care, KindHealth’s team of Licensed Medicare Advisors are just one free phone call away, ready to assist you, answer all your questions, and even enroll in coverage. It’s Medicare expertise — right at your fingertips.

Tags: Health, Care, Medicare

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