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Medicare Minute: What does Original Medicare Cover?

Medicare Minute: What does Original Medicare Cover?

July 17, 2023

When it comes to Medicare, we have found that people have some misconceptions about what Medicare covers. This blog installment will try to break down those services that are covered and, in some cases, more importantly, what Medicare does not cover.

As a quick reminder, Medicare is a federal health insurance program in the United States that provides coverage for individuals aged 65 and older, as well as certain younger individuals with disabilities. Medicare is divided into different parts, with Part A and Part B being the foundation of the program. Part C (Medicare Advantage) plans which some Medicare members have ARE NOT original Medicare – these plans are Managed Care plans that incorporate benefits of Part A and B as well as additional benefits. For purposes of this blog, we are only addressing what Original Medicare Part A and B covers alone.

Medicare Part A, often referred to as hospital insurance, primarily covers inpatient hospital care, skilled nursing facility care, home health services, and hospice care. This includes necessary hospital stays, surgeries, nursing services, and some prescription drugs administered during a hospital stay.

On the other hand, Medicare Part B, also known as medical insurance, focuses on outpatient services and preventive care. Part B covers doctor visits, outpatient surgeries, diagnostic tests, durable medical equipment, ambulance services, and preventive services like screenings and vaccinations. Part B also includes certain medically necessary services, such as physical therapy and mental health care.

While Medicare A and B provide substantial coverage, it's important to note that there are gaps in the coverage they offer. Neither Part A nor Part B covers prescription drugs, dental care, vision care, hearing aids, cosmetic procedures, massage therapy or long-term custodial care. These services often require additional coverage through Medicare Part D (prescription drug coverage), private dental and vision insurance, or standalone insurance plans (Some Part C plans do cover these additional services).

In summary, to ensure comprehensive coverage, it's crucial to explore additional Medicare plans and supplemental insurance options that cater to specific healthcare needs beyond the scope of Parts A and B.