What Does Medicare Cover?

If you’re eligible for Medicare and ready to explore your options, the first step is to get to know its four parts. Each part represents a different kind of coverage.

Part A

Also called hospital insurance, 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. Most people are enrolled automatically in Part A when they reach age 65.

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 you may be required to pay after you've met your deductible. 

If you or your spouse receives Social Security benefits, you don't have to pay a monthly fee to have Part A and will be automatically enrolled.

If you or your spouse doesn't receive Social Security benefits, either because you are still working or because you don’t qualify, you will need to join through your local Social Security office. You will have to pay a monthly fee to have Part A if you are not eligible for Social Security benefits.

Part B

Also called medical insurance, Part B covers outpatient care. For instance, it pays for your visits to a doctor’s office, tests, and preventive care like cancer tests and vaccines.

Part B also covers some medical supplies, like blood sugar test strips, therapeutic shoes, and more. It’s common for people to be automatically enrolled in Part B, too.

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 other care. You have to meet your deductible first and then pay 20% of the services you receive.

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

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Part C, Medicare Advantage

Medicare Advantage is a Medicare health plan that you can get from a private insurance company. This plan 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.
 

Part D, Prescription Drug Benefit

If you use Medicare, you can join a private health plan that pays for prescription drugs. This coverage is called Part D, or the Medicare prescription drug benefit. Each insurance company that offers a Part D plan decides which drugs it will cover and what they will cost. Look carefully at the details of each plan before you choose one.

You pay a monthly fee, called the premium, to get prescription drug coverage. You still pay the monthly fees for Part B if you have it.

You can also get Part D benefits by joining one of these plans:

  • A Medicare Advantage (Part C) plan that has a prescription benefit
  • A Medicare Cost Plan with prescription medicine benefits

The premium you pay for one of these plans includes medicine coverage.

You need to decide whether to get Part D coverage as soon as you're eligible. If you wait, you may have to pay a penalty for joining late.

If you can't afford a prescription drug plan, financial help may be available.

For more information or to get help, you can visit your local State Health Insurance Assistance Program (SHIP). Each SHIP has people trained to help you understand your Medicare benefits and answer questions you have about your Medicare coverage.

WebMD Medical Reference Reviewed by Sarah Goodell on October 09, 2017

Sources

SOURCE:

Medicare.gov: ''Medicare & You'' handbook, "The Affordable Care Act & Medicare."

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