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Health Care Reform:

Health Insurance & Affordable Care Act

What Does Medicare Cover?

The first thing to learn about Medicare is its different parts. Together, Part A and Part B are called original Medicare or traditional Medicare.

Part A

A lso called hospital insurance, Part A is part of traditional Medicare. Most people are enrolled automatically in Part A when they reach age 65.

Medicare Part A covers the cost if you are admitted to a hospital, skilled nursing facility, or hospice. It also covers some home health services.

With Part A, you'll pay:

  • A deductible each year. This is how much you have to spend before Medicare starts to pay its part.
  • Coinsurance. This is the part of the costs for hospital care after you've met your deductible.

If you or your spouse worked for 10 years or more in the U.S., you don't have to pay a monthly fee to have Part A. 

If you or your spouse did not work at least 10 years in the U.S., you have to pay a monthly fee to have Part A. The amount is more if you or your spouse worked less than 7.5 years in the U.S.

Part B

Also called medical insurance, Part B is part of traditional Medicare, and it's common for people to be automatically enrolled. Medicare Part B covers outpatient care. For instance, it pays for visits to a doctor’s office, tests, and preventive health care like cancer screenings and vaccines. Part B also covers some medical supplies, like blood sugar test strips, therapeutic shoes, and more. 

 For Medicare Part B, you pay:

  • A monthly fee
  • A deductible, which is a set amount you pay each year before Part B starts paying for any of your care
  • Twenty percent of the Medicare-approved amount for some types of care. These are doctor's appointments, physical therapy, diabetes supplies, durable medical equipment like commode chairs, wheelchairs, and others. You have to meet your deductible before you start paying 20%.

If you see a doctor who has not signed an agreement to accept Medicare-approved amounts, you will pay more -- possibly up to the full cost -- for a doctor's visit and care.

Part C, Medicare Advantage

Medicare Advantage is a kind of Medicare health plan that you can get from a private insurance company. This kind of health plan still gives you all the benefits you get with traditional Medicare and possibly more.

Some Medicare Advantage plans include prescription medicine coverage (Part D). You may also get coverage for dental, hearing, vision, and wellness programs.

When you have Medicare Advantage, you have to follow all of the plan's rules. For instance, you need to use doctors in the plan’s network. 

Plans may have different limits on out-of-pocket costs. So make sure to compare plans before you sign up for one.

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