What does Medicare Cover

Medicare covers a large variety of benefits and services depending on the plan(s) you purchase. Benefits vary between Parts A, B, C (Advantage), D, and supplements.

Coverage Under Parts A and B (Original Medicare)

Original Medicare (Parts A and B) offer low-cost, basic, and very necessary coverage. Part A covers short-term, emergency nursing home and hospital stays:

  • Hospital Inpatient Care (Up to 60 Days)
  • Nursing Facility Care (Up to 60 Days)
  • Nursing Home Care (Upon Approval)
  • Hospice Care (Upon Approval)
  • Home Health Services (Upon Approval)

Part B covers a huge variety of various medical benefits, including anything that is Medicare-approved and deemed “medically necessary” by your doctor. This can include benefits such as:

  • Clinical research  
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health services
  • Partial hospitalization
  • Preventative services (flu shots, vaccines, etc.)

Medicare Advantage (Part C) Coverage

Part C (Medicare Advantage) is an all-in-one alternative to Original Medicare. As long as you’re eligible for both Part A and Part B, you can choose to enroll in Part C instead. No matter what, all Part C plans will include all of the same coverage as Original Medicare, as well as potentially Part D and some limited dental, vision, and hearing coverage.

Medicare Advantage functions on a network of healthcare providers. Within this network, your out-of-pocket costs are reduced. Each Advantage plan’s coverage will look a bit different, but they all work based on this principle. There are 5 different types of plans:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-For-Service (PFFS)
  • Special Needs Plans (SNPs)
  • Medicare Medical Savings Account (MSA)

Part D Prescription Drug Coverage

Part D covers virtually any and all prescription drugs. The amount you pay, however, depends on the plan and type of prescription. Prices and coverage are categorized into 5 different tiers, each tier with different required out-of-pocket costs call coinsurance or copayment fees:

  • Tier 1: $1 to $3 Coinsurance, Covers Preferred Generic Prescription Drugs
  • Tier 2: $7 to $11 Coinsurance, Covers Generic Drugs
  • Tier 3: $38 to $42 Coinsurance, Covers Preferred Brand Name Drugs
  • Tier 4: 45% to 50% Copayment, Covers Non-Preferred Drugs
  • Tier 5: 25% to 33% Copayment, Covers Specialty Drugs

What Medicare Supplements Cover

Medicare supplements are an additional-coverage plan that can literally “supplement” your Original Medicare plan. They cover a vast amount of extra benefits. There are 10 different plans—A, B, C, D, F, G, K, L, M, and N. Of these plans, Plan F covers the most—any of the other 9 will have some variation of these benefits:

  • Part A Coinsurance & Hospital Costs
  • Part B Coinsurance/Copayment
  • First 3 Pints of Blood for Transfusions
  • Part A Hospice Care Coinsurance/Copayment
  • Skilled Nursing Care Facility Coinsurance
  • Part A Deductible
  • Part B Deductible
  • Part B Excess Charges
  • 80% of Foreign Travel Emergency Care

Original Medicare does NOT cover:

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The typical enrollment age for Medicare is 65. Those with a qualifying diagnosis may be able to enroll in Medicare before that age. If you’re wondering whether or not you qualify for Medicare, reach out to our professionals today at 941-773-9953 or use our contact form. We look forward to hearing from you and discussing your insurance options.