Medicare Coverage by Topic
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Medicare Coverage by Topic
- Original Medicare -- Part A
- Original Medicare -- Part B
- What about Medicare coverage when you're not yet 65, but you have a disability?
Original Medicare is government-sponsored health insurance that includes Part A (hospital insurance) and Part B (medical insurance). It can be confusing to figure out which services Medicare covers, and which it doesn’t. Read more below to learn about the Medicare benefits you may be entitled to under Original Medicare.
Original Medicare — Part A
In general, Medicare Part A benefits include care you get as a hospital inpatient. For example:
- Skilled nursing services
- A semi-private room
- Medications are given to you as part of your inpatient treatment
- Hospital services and supplies
Medicare hospital coverage: If your enrolled in Medicare and your in the hospital, it’s important to know whether you’re considered an inpatient or an outpatient. This can affect how much you pay for your care. If your Medicare doctor has admitted you to a hospital as an inpatient, Medicare Part A applies. It’s possible to stay overnight at a hospital and still be an outpatient, in some cases (for example, if you’re undergoing observation). If you haven’t been admitted as an inpatient, Medicare Part B coverage usually applies.
Original Medicare — Part B
Medicare Part B covers many types of doctor visits and medical services. Please note that Medicare coverage applies only if certain conditions are met (for example, a service may have to be medically necessary and delivered in a Medicare-enrolled facility). Costs such as copayments and deductibles may apply. This is not a complete list.
- Preventive services, such as annual checkups (wellness) and vaccinations
- Durable medical equipment (DME)
- Mental health services
- Ambulance services
- Diabetic supplies
- Second opinion prior to surgery
Some services may be covered under Medicare Part A, Part B, or partially by both, depending on the situation. For example, cataract surgery may be outpatient surgery (covered by Part B) or inpatient surgery (covered by Part A).
About Medicare prescription drug coverage: Original Medicare (Part A and Part B) typically doesn’t cover medications you take at home. Part A covers drugs you get as part of hospital inpatient care, and Part B covers certain drugs you may get as an outpatient – these are usually drugs that need to be administered to you at your doctor’s office. For most prescription drug coverage, you need to sign up for Medicare Part D. This optional coverage is available from private, Medicare-approved insurance companies.
What about Medicare coverage when you’re not yet 65, but you have a disability?
If you’re eligible for Social Security or Railroad Retirement Board disability benefits, you might qualify for Medicare. Learn more about Medicare and disability, including when your Medicare benefits may start.
Medicare Advantage (Medicare Part C)
People usually don’t pay a monthly premium for Medicare Part A coverage if they or their spouse paid Medicare taxes while working. For Medicare Part B, most people pay a standard monthly premium. Some people may pay a higher Medicare Part B premium based on their income. Additional information about Part B premiums can be found on our Medicare Part B page.
There are some things Original Medicare doesn’t cover, such as routine dental or vision services, or prescription drugs in most situations. Many Medicare Advantage (Medicare Part C) plans do offer such benefits. Medicare Advantage plans are offered by private insurance companies approved by Medicare and must include at least as much coverage as Medicare Part A and Part B (except hospice services, which Medicare Part A covers even if you have a Medicare Advantage plan). Costs and availability of Medicare Part C plans vary, but you continue paying your Medicare Part B premium when you’re enrolled in a Medicare Advantage plan.
Medicare information is everywhere. What is hard is knowing which information to trust. Because Medicareprofessionaladvisors are following the CMS regulations, you can rest assured you’re getting accurate information so you can make the right decisions for your coverage.
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Medicare Part A
Part A of Medicare covers hospitalisation. Inpatient treatment, limited time in a licenced nursing facility, limited home health care services, and hospital care are all covered under Part A.
Medicare Part B
Non-hospital medical costs such as doctor's appointments, blood tests, x-rays, diabetes testing and supplies, and outpatient hospital treatment are covered by Part B benefits. For this component of the original health insurance, you pay a monthly fee.
Medicare Part C
In a health insurance plan, Medicare Advantage or Medicare Part C normally covers all forms of health insurance coverage. Private insurance businesses that have been contracted by the CMS to provide a medicare plan as an alternative to the original health insurance plan provide it.
Medicare Part D
Medicare Part D is a prescription medication coverage option. Part D health insurance is available as a stand-alone plan from private insurance firms, with monthly rates varying from one to the next. Depending on the plan you're registered in, you'll split the cost of your prescription medicines.
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You get the same coverage as Original Medicare plus additional benefits from the Medicare Advantage insurance provider when you enroll in a Medicare Advantage plan.
There are many of savings to be had, but here are a handful you might not be taking advantage of right now:
- Your Social Security benefit will be reduced by $144 each month.
$2,500 to spend on dental procedures such as crowns, implants, and dentures.
- $1,000 to spend on vitamins and aspirin at your neighbourhood drugstore
- Hearing aids and batteries cost $2,000
- $300 will be used on eyeglasses and tests.
It’s not simple to learn the ins and outs of Medicare. While Medicare.gov has a wealth of information, there is no real how-to when it comes to determining what is best for you and your lifestyle.
This is where we can help! We put our 20+ years of industry experience to work for you, giving you the peace of mind that you’re getting what you’re entitled to without the hassle.
- Initial Enrollment Period – Most persons can enrol in Medicare Part A, Part B, Part C, and/or Part D for the first time within a seven-month period: three months before, three months during, and three months after they reach 65.
- Special Enrollment Period (SEP) – Certain life circumstances, including as moving or losing current coverage, may qualify you for coverage. You usually have two months to enrol, depending on your circumstances.
- Medicare Part C & D Annual Enrollment Period (AEP) – Every year, from October 15 to December 7, Existing Medicare beneficiaries can take advantage of this time to review and adjust their Medicare Advantage (Part C) and Medicare prescription medication plans (Part D). You cannot utilise AEP to enrol for the first time in Part A and/or Part B. The following year’s coverage begins on January 1st.
- Medicare General Enrollment Period – Every year, from January 1 to March 31, While the majority of individuals will receive Part B coverage when they join in Medicare, this period is allocated for those who did not enrol in Part B when they initially became eligible. Coverage begins on July 1st of the following year.
- Medicare Advantage Open Enrollment Period (OEP) – Every year, from January 1 to March 31, You can change to a different Medicare Advantage plan with or without medication coverage during this period, or move to Original Medicare and join a separate Medicare Prescription Drug plan. You cannot, however, go from Original Medicare to a Medicare Advantage plan, join a prescription drug plan while on Original Medicare, or change from one prescription drug plan to another prescription drug plan while on Original Medicare.