What does it cover

What Medicare Covers

There are 5 main options with Medicare that offers various healthcare benefits to individuals who are above the age of 65 and individuals with some chronic ailments and disabilities:

  • Basic coverage for hospitalization is covered by Medicare Part A.
  • Outpatient care, including diagnostic tests and doctor’s visits are covered by Part B of Medicare.
  • Medicare Part C (Medicare Advantage) is a private option that combines Part A and Part B coverage and offers additional benefits.
  • Medicare Part D is prescription drug coverage.
  • Medicare supplement (Medigap) is private insurance that helps cover out-of-pocket costs like copays, coinsurance, and deductibles.

When you are dealing with healthcare it is vital that you know what you are covered for and what you won’t be covered for. There are so many Medicare plans it can often be confusing in deciding which plan is going to give you the best coverage.

Medicare is a federal government insurance plan it is for individuals who are 65 years of age or older along with those who have ESRD or end-stage renal disease or disabilities. There are 4 parts to any Medicare Plan, including A, B, C and D and each of these parts would cover various healthcare aspects.

You can choose to enroll yourself in 1 or more Medicare parts, but the most commonly used parts are both A as well as B, which is also called the Original Medicare. This would cover a majority of any services you would need and some people pay a premium monthly, but this depends on your income.

Medicare Part A

Medicare Part A covers hospital inpatient costs when you are formally admitted to a hospital with a doctor’s order. It provides benefits for services like:

Part A also provides limited coverage for skilled nursing facilities if you have a qualifying inpatient hospital stay — three consecutive days resulting from a formal inpatient admission order written by your doctor.

What does Medicare Part A cost?

Depending on how much you make you might have to pay a monthly premium for coverage under Part A. However, if you paid your FICA taxes for at least 10 years while working, then you don’t have to pay a premium to get Part A coverage. However, deductibles and copayments might be required that you would have to pay for the services availed under Part A of Medicare. You will be able to apply for help or assistance if you can’t pay.

According to Medicare, in addition to a $1,484 deductible, your 2021 Part A costs include:

  • $0 coinsurance for hospitalization days 1–60
  • $371 coinsurance per day for hospitalization days 61–90
  • $742 coinsurance per day for hospitalization day 91 and beyond for each lifetime reserve day
  • all costs for each hospitalization day over your lifetime reserve days
  • no charge for the first 20 days of approved skilled nursing facility care
  • $185.50 per day for 21–100 days of approved skilled nursing facility care
  • all costs after 101 days of approved skilled nursing facility care
  • no charge for hospice care

If you want the hospital services to be fully covered under Medicare, then you need to get approval and get the care at a facility approved by Medicare.

Medicare Part B

Medicare Part B covers your doctor’s services and preventive healthcare, such as yearly doctor visits and tests. People often have parts A and B together to get the most coverage. For example, if you stay in a hospital, the stay would be covered under Medicare Part A and the doctor’s services would be covered under Part B.

You get a wide variety of coverage for services and tests under Part B, including

  • screening for cancer, depression, and diabetes
  • ambulance and emergency department services
  • influenza and hepatitis vaccinations
  • medical equipment
  • diabetes supplies

What does Medicare Part B cost?

Some of the cost that you are paying for Part B is going to be the monthly premium, which depends on your income, but is at $148.50. There are some services that Part B would cover with no extra cost to you if your doctor accepts Medicare. For those who need services outside of what Medicare covers, then this part would have to be borne by you.

Medicare Part C

Medicare Advantage is also known as Part C of Medicare and it is insurance that is privately sold. This however, includes the same coverage as Medicare Parts A along with B with some extra benefits like vision, hearing, dental and prescription drug coverage. Before you can purchase one of these Advantage plans you need to be enrolled for the Original Medicare.

What does Medicare Part C cost?

You would normally pay your premium for this coverage and you need to make sure the doctors that you are seeing are part of your network. Otherwise, various fees and copays would be applicable and the cost of Part C Medicare depends directly on the plan type that you choose.

Medicare Part D

Prescription drugs are covered under Part D of Medicare and it includes those drugs that aren’t covered under the Part B. this means that they are often the medications that a doctor would need to administer like an injection or infusion. This is an option plan, but the majority of the enrollees choose it so that all of their medications would be fully covered.

What does Medicare Part D cost?

The cost you would be paying for Part D of Medicare is dependent on the medications that you choose, the pharmacy that you are going to use and the plan that you picked. You are going to have to pay for the premium and there might be additional costs to pay, including a deductible or copays.

What Medicare doesn’t cover

Medicare covers a huge range of healthcare needs, but that doesn’t mean that everything would be covered. Most acupuncture, hearing aids, eye exams, dental care and cosmetic surgeries aren’t going to be covered using Original Medicare.

It also doesn’t cover any long-term care that you might need, so if you or one of your loved ones would need this, then you need to consider getting an insurance policy for long-term care.

The Takeaway

  • Medicare has 5 main coverage types, including Part A, B, C, D along with Medigap that would give you numerous options to cover all of your healthcare requirements.
  • There are some medication services that Medicare doesn’t cover, but it does cover prescription drugs, doctor visits and hospitalization.
  • Long-term care along with cosmetic procedures and other items aren’t covered by Medicare, so make sure you know what is covered by Medicare coverage tool.