What Does Medicare Cover?
Medicare is a federal health insurance program that provides coverage for millions of Americans. Generally, it covers most hospital and medical services, including doctor's visits, preventive care, and check-ups. It also covers some of the costs associated with long-term care and prescription drugs. Depending on the individual's circumstances, Medicare can be a great way to access the health care they need.
There are four parts to Medicare: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Plans), and Part D (Prescription Drug Coverage). Each part of Medicare has its own eligibility requirements and coverage levels.
Part A of Medicare is hospital insurance. It helps cover the costs associated with inpatient care in a hospital or skilled nursing facility. This includes care from doctors and other healthcare professionals, as well as room and board. Part A also covers some home health care services and hospice care.
Who is eligible for Part A? Generally, individuals who are over 65 years old and have worked for at least 10 years are eligible for Part A. There are also exceptions for certain individuals, such as those who are disabled or have End-Stage Renal Disease. To get coverage, you must apply and pay a premium.
Medicare and its Four Parts
Medicare is a health insurance program provided by the federal government for citizens over the age of 65, as well as individuals with certain disabilities. It is divided into four parts which provide different levels of coverage and eligibility requirements.
Part A is known as hospital insurance and covers certain inpatient services and treatments such as hospital stays, nursing home care and hospice care. Part B is referred to as medical insurance and primarily covers doctor’s visits, medical tests and procedures. Part C, also known as Medicare Advantage plans, is an option for those who wish to combine Parts A and B in a single plan. Part D is prescription drug coverage and helps patients cover the costs of medications.
It is important to understand the coverage and eligibility requirements of each part of Medicare to make sure you are getting the most out of your benefits.
What Hospital Services are Covered Under Part A?
Medicare Part A is the part of Medicare that helps to cover hospital services. It provides coverage for inpatient care in a hospital or skilled nursing facility as well as home health care and hospice care. It can also help pay for certain types of medical equipment.
If you are admitted as an inpatient to a hospital or skilled nursing facility, Part A will pay for semi-private rooms, meals, general nursing services, medications related to your care, lab tests, certain medical supplies and equipment, rehab services, and more. If you require home health care, Part A covers services such as part-time or intermittent skilled nursing care, physical therapy, and speech-language pathology services.
Part A also covers hospice care if a doctor confirms that you have a terminal illness and you decide to receive hospice care at home or in a hospice facility. This coverage includes medical services and equipment, as well as counseling services for you and your family.
If you need durable medical equipment like a wheelchair, walker, or hospital bed, Part A may cover the cost or part of the cost. This coverage is limited, however, so it is important to check with your doctor or Medicare provider about what is covered.
Eligibility and Enrollment for Part A
Medicare Part A is the hospital insurance part of Medicare, meaning it helps cover inpatient hospital care, certain skilled nursing home care services, hospice, and home health visits. To be eligible to receive Part A, somebody either needs to be 65 years or older and a U.S. citizen or have a qualifying disability.
If somebody doesn’t have to pay for Part A, they are considered “automatically enrolled” and will receive their card three months before their 65th birthday. For those enrolled in Social Security disability benefits, enrollment usually begins the 25th month of receiving disability payments.
If someone has to pay for Part A, usually they have to wait until the general enrollment period, which runs from January 1 through March 31 each year. Coverage will begin July 1st of that same year. People can choose to enroll in Part A if they have an employer group health plan, even if they don’t have to pay for it, to help cover some of the costs not paid by their employer group health plan.
It is important to note that if someone didn’t sign up for premium-free Part A when they were first eligible, they may have to pay a late enrollment penalty. The penalty is an extra 10% for each 12-month period that someone could have had Part A but didn’t sign up for it.
What Does Medicare Cover? - Part B Medical Services
Medicare Part B covers a range of medical services that help you receive preventive care, diagnose and treat illnesses or injuries, and manage chronic conditions. All services covered under Medicare Part B must be medically necessary. Examples of medical services covered by Part B includes:
- Visits to your doctor, specialist, or another healthcare provider.
- Diagnostic tests, such as blood tests, X-rays, CT scans, MRIs, and lab tests.
- Certain preventative services like flu shots, diabetes testing supplies, cancer screenings, and vaccinations.
- In-hospital treatments like hospice care, ambulance services, mental health services, and skilled nursing facility care.
- Medical equipment like crutches, wheelchairs, walkers, oxygen tanks, and certain prosthetics.
Part B also covers some forms of home health care, including skilled nursing care, physical therapy, and occupational therapy.
Who is Eligible for Part B?
Medicare Part B is available to most people who are 65 and over, or those who are on disability benefits through Social Security or the Railroad Retirement Board. Some individuals may also be eligible if they have certain health conditions, such as end stage renal disease (ESRD) or Lou Gehrig's Disease (ALS).
In order to qualify for Medicare Part B, you must be a U.S. citizen or permanent legal resident for at least five consecutive years prior to your application. You must also have worked within the United States for the minimum time required by law in order to qualify.
Coverage Levels Available with Part B
Medicare Part B provides coverage for physician services, outpatient hospital services, preventative care, diagnostics, and durable medical equipment such as wheelchairs and hospital beds.
Part B also provides benefits for mental health services, home health services, medical transportation, and limited prescription drug coverage. Depending on the type of service you need, there may be different coverage levels available. For example, you may be able to get full coverage for some services, while you may only receive partial coverage for other services.
It is important to understand your coverage options before seeking medical treatment. That way, you can plan for the cost of any services that may not be fully covered.
Part B Costs
Medicare Part B comes with a cost, which could potentially include premiums, deductibles, coinsurance, and copays. Understanding what these costs are and how they work is important for people who want to make sure they are properly covered by Medicare.
Premiums
Premiums are monthly payments that you make to Medicare to keep your Part B coverage. The amount you pay in premiums usually depends on your income. The higher your monthly income, the higher your premium will be. Most people pay a standard premium of $148.50 per month in 2020, while those with higher incomes may pay more.
Deductibles
A deductible is an amount that you may have to pay before Medicare begins to cover your healthcare services. For Medicare Part B, the deductible amount is $198 in 2020. Once you pay this amount in out-of-pocket costs for covered healthcare services, Medicare will start picking up the tab for most of your expenses.
Coinsurance and Copays
Once you reach the deductible, you may still have to pay a portion of the costs for some of your healthcare services. This is called coinsurance. Depending on the type of service you receive, you may pay a percentage of the costs (for example, 20%) or a fixed amount (for example, $30). Additionally, some providers may charge a copayment, which is a fixed fee that you pay out of pocket.
Part C: What Does it Cover?
Part C of Medicare is also known as Medicare Advantage. This part of the program offers a variety of health plans that are run by private companies and include features such as dental, vision and prescription drug coverage.
The plans offered under Part C vary in cost and benefits. Some plans offer more comprehensive coverage, while others may be more affordable. It's important to shop around and compare plans to find one that offers the most value for you.
Types of plans available through Part C include HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Accounts.
HMOs often limit their members to using the doctors and hospitals within their network. PPOs offer more flexibility, allowing members to use any doctor or hospital, though they may pay more when seeing an out-of-network provider. Private Fee-for-Service plans let members use any doctor or hospital, but they must accept the plan's payment for services. Special Needs Plans are designed for people with certain chronic medical conditions. Finally, Medicare MSA plans combine a high deductible medical plan with a bank-like account to help cover the costs.
It's important to understand the different plans available to choose the one that is best for you. You can compare plans online or by calling 1-800-MEDICARE.
Who is Eligible for Part C and How to Enroll
Part C of the Medicare program, also called Medicare Advantage, is a special type of health care provided by private companies. In order to qualify for Part C coverage, you must first be enrolled in Medicare Parts A and B, which provide basic hospital and medical coverage.
Eligibility requirements for Part C are similar to those of Parts A and B, and you must meet certain criteria in order to be considered eligible:
- You must be age 65 or older, or disabled.
- You must be a U.S. citizen or permanent resident.
Once you have determined that you are eligible for Part C, the next step is to enroll in a plan. You can do this through an online marketplace offered by Medicare or through a private insurance company. Most plans require a monthly premium along with other out-of-pocket costs such as coinsurance or copayments.
It is important to research the different plan options available to ensure you find the one that best fits your needs and budget. It is also important to review all plan documents carefully before signing up. This will ensure you understand all of the costs and coverage details associated with the plan.
Medicare Part D
Medicare Part D is a prescription drug coverage provided by the U.S. government. As with other parts of Medicare, it's available to certain eligible individuals who meet specific criteria. Part D is designed to help reduce the costs associated with prescribed medications for those who qualify.
To be eligible for Part D, you must already be enrolled in Medicare Part A or Part B. You will need to enroll in a stand-alone plan, or a Medicare Advantage plan with built-in prescription drug coverage, and pay monthly premiums. When selecting a Part D plan, be sure to compare the various coverage options and costs to ensure that you choose the plan that best meets your needs.
Once enrolled in a Part D plan, you will have access to a network of pharmacies that accept your plan. If you have a chronic condition, you may also be eligible for extra help with prescription drug costs. You can apply for this assistance through the Social Security Administration, or your state Medicaid office.
When signing up for Part D, you may have an initial deductible or co-payment that you must pay before your prescription drugs are covered. After that, you may have additional expenses that you will need to pay out of pocket, such as coinsurance or copays. Be sure to read through your plan's information carefully to understand any potential out-of-pocket costs.
If you are eligible for Part D and would like more information about the program or how to enroll, contact your local Social Security Administration office for more information.
Summarizing Medicare and its Four Parts
Medicare is an extensive health insurance program in the United States that provides coverage for seniors and certain disabled individuals who meet certain eligibility requirements. It’s important to understand the different parts of Medicare, so you can make informed decisions about your health care.
Medicare is made up of four different parts: Part A, Part B, Part C, and Part D. Each part covers different types of services, and each has its own eligibility requirements and costs.
Part A helps cover the costs of hospital stays, home health care, and certain types of rehabilitative care. Part B helps cover the costs of doctor visits and other outpatient services. Part C allows individuals to receive their Part A and Part B benefits through private health plans. Part D helps cover the cost of prescription drugs.
To be eligible for Medicare, you must be a U.S. citizen or permanent resident who is age 65 or older or meet certain disability or special circumstances requirements. To access Medicare benefits, you’ll need to enroll in the program and pay any applicable premiums, deductibles, coinsurance, and copayments.
In summary, Medicare is an important health insurance program in the United States, and its four parts offer coverage for different types of medical services. Understanding the different parts of Medicare and who’s eligible can help you make informed decisions about your health care.
Conclusion and Resources
If you have read this guide, you now have an understanding of what Medicare covers and have a better idea of which of its four parts might suit your needs. It is ultimately up to you to decide what healthcare coverage is the best fit for your situation.
If you would like more information about Medicare, there are many excellent resources available. Here are just a few:
- Medicare.gov, which offers official information from the U.S. government about Medicare and its parts
- HealthCare.gov, which provides more detailed information about healthcare plans available through Medicare as well as in different states
- Medicare Rights Center, which provides answers to many common questions along with other support resources for Medicare enrollees
- Medicare Advocacy Project, which provides advice on health insurance options available to those over 65 years of age
We hope this guide has been helpful in answering your questions about what Medicare covers and the different parts that are available. For more information, please visit one of the websites listed above.
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Diane Carbo