What Medicare Does And Does Not Cover

The government helps seniors pay for healthcare through Medicare. Here is what the insurance program does and does not cover.

Medicare Basics

Enrolling in Medicare gives you some options in terms of coverage. The first is Original Medicare, which offers Medicare Part A and B. Part A covers hospital insurance, while Part B focuses on medical insurance. Medicare Part D can be added separately if you want prescription drug coverage. You can also get Medicare Supplement Insurance (Medigap) to cover some of your out-of-pocket expenses.

It’s a good idea to get Part D and Medigap coverage when you first become eligible for Medicare. If you get it later on, you could end up paying more via a lifetime premium penalty. As long as a hospital or doctor accepts Medicare, you can use them no matter where you are in the U.S.

If Original Medicare doesn’t suit your needs as a senior, you can choose the second coverage option, a Medicare Advantage (Part C) plan. This alternative to Original Medicare attracts seniors seeking an all-in-one solution that bundles Part A, B, and D plans together.

While a Medicare Advantage Plan can lead to lower out-of-pocket costs, there is a downside of choosing doctors within a network. Some seniors may be okay with this since Part C plans offer extra perks like dental, hearing, and vision benefits that make the network limitation worth it.

What Medicare Part A Covers

As mentioned, Medicare Part A covers hospital insurance, which includes the following:

• Inpatient hospital care
• Home health care
• Nursing home care
• Skilled nursing facility care
• Hospice care

What Medicare Part B Covers

Medicare Part B coverage splits into two main categories: Medically necessary services and preventive services. The first category deals with supplies or services used to diagnose or treat medical conditions. The second covers services needed to detect or prevent illness before it gets worse. Most preventive services come at no cost, as long as you choose a healthcare provider that accepts assignment. Here’s a sample of free preventive screenings and services from Medicare Part B:

• Alcohol misuse
• Bone mass measurements
• Cardiovascular disease
• Cervical cancer
• Colorectal cancer
• Depression
• Diabetes
• Flu shots
• HIV
• Lung cancer
• Mammograms
• Obesity
• Prostate cancer

Part B coverage includes such items as:

• Ambulance services
• Clinical research
• Durable medical equipment
• Certain outpatient prescription drugs
• Mental health, whether it involves inpatient/outpatient care or partial hospitalization

What Medicare Part a and B Do Not Cover

• Acupuncture
• Cosmetic surgery
• Dental care
• Hearing aids
• Eye exams
• Foot care
• Long-term care

What Medicare Advantage Plans Cover

These plans will give you all of the coverage of Original Medicare, plus extras like:

• Dental
• Hearing
• Vision
• Wellness programs
• Transportation to doctors
• Adult daycare
• Over-the-counter medicine

How To Find Out What Medicare Covers

While the lists above give you a general glimpse into what Medicare does and does not cover, there’s a tool you can use to get details on specific services. Go here to enter the test, item, or service, and the tool will let you know whether or not Medicare covers it.