What medical services does Medicare cover?
Original Medicare includes Part A and Part B. It is a good ‘safety net’, although these plans do not cover everything, and only 80% of charges for covered medical services are paid. Beneficiaries have to share the costs for most medical services they receive with original Medicare including deductibles, co-pays and co-insurance. Medicare also does not cover routine dental, hearing and vision. For many persons on Medicare it is difficult to afford the 20% that are not paid by Medicare.
Fortunately, if you want more or better coverage, or put a cap on high medical expenses, there is additional insurance you can add to your original Medicare such as Medicare Advantage or Medicare Supplement Plans.
Medicare Advantage plans often include additional benefits such as prescription drugs, for a premium that may not higher than what you already pay for your plan B premium, while Medicare Supplement plans help you cap costs for co-payments, coinsurance and your annual deductibles.
Following are the services that are included in original Medicare:
Medicare Part A Services:
Medicare Part A helps cover your inpatient care in hospitals and skilled nursing facilities. It also covers hospice care and some nursing home and home health care. Attention, this is NOT the typical care in a nursing home, but strictly limited to medically necessary skilled care after a hospital stay for the same condition! You must meet certain conditions, and the services must be approved and rendered by health care providers that are accepted by Medicare. Deductibles, co-payments and co-insurance apply.
- Hospital Stays
- Skilled Nursing Facility Care
- Home Health Care
- Hospice Care
- Blood
Medicare Part B Services:
Medicare Part B helps cover your doctors’ services, outpatient hospital care, and some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. You pay the Medicare Part B premium. Deductibles, co-payments and co-insurance apply!
Medical and Other Services: Doctors’ services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speech-language therapy.
Clinical Laboratory Services: E.g. blood tests
Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services.
Outpatient Hospital Services: Hospital services and supplies received as an outpatient as part of a doctor’s care.
Blood: Pints of blood you get as an outpatient or as part of a Part B covered service.
Original Medicare also helps cover durable medical equipment such as crutches and wheelchairs.
Everybody on Medicare is encouraged to learn about which programs and services are and which are not covered by original Medicare, and to check their options to add additional coverage with Medicare advantage or Medicare supplement plans that may better fit into their overall health and wellness plan – and in their financial budget now and in the future. Also – even if you currently don’t need to take many prescription drugs, it is very important that you consider enrolling in a Medicare prescription drug plan in order to help you lower your medication costs. Make sure you have the opportunity to compare Medicare quotes from different insurance providers, before you decide on a plan.
This information was complete and current at the time of this post, but it might be outdated or incorrect. Please visit Medicare.gov for detailed and current information.
