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Medicare Coverages

What Does My Medicare Cover?

When it comes to signing up to Medicare and choosing the plan that’s right for you, it’s important to know what Medicare covers.  While some people think Medicare is free and covers everything they need, the unfortunate reality is that’s not entirely true.  In this article, we will explore what things Medicare does (and does not) cover.

Medicare Parts

First, it’s important to know the way Medicare is provided.  Medicare comes in different parts: Part A, B, and D, that cover different healthcare services.  Here is a simple breakdown: 

Medicare Part A 

Medicare Part A can be thought of as covering “the big stuff”.  This covers more expensive, long-term, and specialized healthcare needs, such as hospital in-patient stays, the costs of nursing homes and hospice, and sometimes in-home care.  This is not an exhaustive list, and there are instances when medicare may not cover a service mentioned here, so it’s important to know what your plan covers.  You can find out if your Medicare plan covers a service you need here.  

Medicare Part B 

 Medicare Part B is the “everyday stuff”:  This covers more routine care, such as doctors’ services, medical supplies, check ups, outpatient services, and preventative care. It may also cover more “catastrophic” things that Medicare Part A doesn’t.  Some of these things include routine exams, such as screening for cancer, depression, and diabetes, ambulance and emergency department services, influenza and hepatitis vaccinations, electrocardiograms (ECGs), medical equipment, some drugs, diabetes supplies, and some prescriptions for eyewear.  That being said, there are many vision procedures and eyewear needs Medicare may not cover.  

What Medicare Parts A & B Don’t Cover

As we mentioned earlier, Medicare doesn’t cover everything. Some of the items and services Medicare doesn’t cover include:

  • Long-term care (also called custodial care )
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery  
  • Acupuncture  
  • Hearing aids and exams for fitting them
  • Routine foot care

If you need services Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or a Medicare health plan that covers them.

Medicare Part C 

Medicare part C is a bit different, as it’s a Medicare Advantage plan. Not everybody has Medicare part C, and you will not be automatically enrolled in Part C as you are in Parts A and B when you turn 65 (if you are drawing Social Security Benefits).  Medicare Part C is similar to a Medigap plan, but it includes a prescription drug plan and it usually comes at little or no cost (but it’s more limited in terms of doctors and coverage, and can be harder to qualify for).

Medicare Part D – Medicare Part D covers your Medications.  This covers prescription drugs, as well as shots and vaccinations.  While this plan is optional, it is highly recommended, especially if you have a chronic condition you take medications for.  You can sign up with Medicare Part D through a licensed private insurance company.  What is and is not covered will depend on the plan you choose, as well as your own circumstances.  

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Disclaimers: Outside of the Medicare Annual Enrollment Period, members can enroll in a plan only if they meet certain criteria. A licensed insurance agent can help you determine whether you are eligible. Plan availability varies by region and state. Callers will be directed to a licensed insurance agent with a third-party partner of MedicareGap.org who can provide more information about Medicare Advantage plans offered by one or several Medicare-contracted carrier(s). Enrollment in any plan depends on contract renewal. Medicare has neither reviewed nor endorsed the information contained in this advertisement. Not connected with, or endorsed by, the U.S. government or the federal Medicare program. This information is not a complete description of benefits. For a complete listing of Medicare plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, 7 days a week, or consult www.medicare.gov.