What Does Medicare Cover?
It’s good to know.
Researched, written by Amber & The Team
Updated on December 16, 2022
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Medicare is a health insurance program run by the government that covers people aged 65 and above or people with chronic illnesses. The program also covers certain younger people with chronic health conditions or disabilities. There are four parts entailed in the Medicare program. This post will discuss in detail what the different Medicare parts cover.
Medicare part A: What Is It?
Medicare part A is a federal insurance program that helps pay for hospitalization and other medical services for eligible seniors and people with disabilities. To be eligible for part A of the insurance program, you must be age 65 or older or have a disability or end-stage renal disease. Most people eligible for Medicare part A doesn’t have to pay a premium, but there is a deductible and copays for some services. If you’re not already receiving Social Security benefits when you turn 65, you’ll need to sign up for Medicare part A (and part B) during your initial enrollment period.
Medicare part A: What does it cover?
1. Inpatient care
This is care that you receive when you’re admitted to the hospital as an inpatient. This can include your doctor’s care, room and board, nursing care, and other hospital services and supplies.
2. Skilled nursing facility care
If you’re discharged from the hospital to a skilled nursing facility (SNF), Medicare part A will help pay for your stay. SNFs provide care for people who need ongoing medical and nursing care but don’t need to be in the hospital.
3. Hospice care
Medicare Part A covers a wide range of hospice services, including inpatient care, home health visits, and respite care. These services are designed to provide comfort and support to patients who are nearing the end of their life. In addition to medical care, hospice services also include counseling, social work, and chaplain services.
4. Home health care
Home health care is a broad term that includes a variety of health care services that can be provided in the home. Medicare Part A covers a limited number of home health care services, physical therapy, speech therapy, and occupational therapy. These services must be ordered by a physician and provided by a Medicare-approved home health agency. In most cases, Medicare will only cover home healthcare services considered medically necessary.
Medicare part B: What Is It?
Medicare part B is a federal insurance program that helps pay for physician services, outpatient care, and some preventive services. To be eligible for Medicare part B, you must be enrolled in Medicare part A and pay a monthly premium.
Medicare part B: What does it cover?
1. Physician services
Medicare Part B covers a wide range of physician services. These include, but are not limited to: office visits, surgery, lab tests, x-rays, and diagnostic tests. In most cases, Medicare Part B will cover 80% of the cost of these services. The remaining 20% is typically covered by supplemental insurance.
2. Preventive care
One of the many types of preventive care covered under Medicare Part B is the screenings and shots that help you stay healthy. These screenings can help detect problems early, when they may be easier to treat. For example, Part B covers cancer, heart disease, and diabetes screenings. It also covers vaccinations for things like the flu, pneumonia, and hepatitis B. In addition to these general screenings and vaccinations, Part B also covers several types of preventive care specific to women. This includes mammograms, Pap smears, and bone density tests.
3. Durable medical equipment
Medicare part B also covers durable medical equipment (DME). DME refers to any equipment that is used for medical purposes and is designed to last for an extended period of time. Common examples of DME include hospital beds, wheelchairs, oxygen tanks, and Walker’s. In order to have your DME covered by Medicare, you must first obtain a prescription from your doctor. You also may need to rent or purchase the equipment from a Medicare-approved supplier. Medicare will then reimburse you for a portion of the cost. The amount you’ll be reimbursed depends on the equipment you’re using and whether you’re renting or purchasing it.
4. Mental health care
Many seniors and people with disabilities or chronic health conditions face unique challenges when it comes to their mental health. Isolation, health conditions, and the loss of loved ones can all lead to feelings of depression and anxiety. Fortunately, Medicare provides coverage for mental health care through Part B. This coverage includes outpatient services such as individual therapy, group therapy, and psychiatric evaluations. In addition, Medicare Part B also covers partial hospitalization, a type of intensive outpatient care that can provide seniors with the support they need to manage their mental health.
Medicare part C
Medicare Part C, also known as Medicare Advantage, is a health insurance plan that provides coverage for all of the services covered under Part A and Part B and some additional benefits. Some extra benefits covered under Part C include prescription drugs, dental and vision care, and hearing aids.
Private insurance companies offer Medicare Advantage plans, which vary in cost and coverage. Because of this, it’s important to compare plans before enrolling in one. Part C plans may also have different rules about what services are covered and how much you’ll have to pay. Be sure to ask about these details before enrolling in a plan.
Medicare part D
This is a voluntary prescription drug benefit for Medicare beneficiaries. Part D plans cover both brand-name and generic drugs. Most plans have a deductible, an initial coverage limit, a gap in coverage (the “doughnut hole”), and a catastrophic coverage limit. There is wide variation in the costs and benefits of different Part D plans. Beneficiaries should carefully compare plans before enrolling.
Medicare Part D plans are not required to cover all drugs; however, they must provide broad coverage of essential drugs in six therapeutic categories: antidepressant medications, antipsychotic medications; anticonvulsant medications; antineoplastic medications; HIV/AIDS medications; and immunosuppressant medications. Some plans also cover other drugs, such as those used to treat erectile dysfunction or weight loss.
Outside of these therapeutic categories, beneficiaries may still be able to get coverage for specific drugs through clinical trials or compassionate use programs.
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