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:
