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What Does Medicare Cover?

Dec 14, 2019 3 min read Ben Gran

If you're planning for retirement, you might be wondering, "What does Medicare cover?" Medicare is America's universal health care program for people age 65 and older. Some people younger than age 65 who have certain health conditions can also receive medical coverage through Medicare.

Signing up for Medicare is a rite of passage as people reach retirement age. Having Medicare can help cover your health care costs for the rest of your life, and it can help you enjoy a more secure retirement. However, Medicare doesn't cover all health care costs, and different parts of Medicare (Medicare Part A, Part B and Part D) cover different types of services.

Even though Medicare covers most major hospital expenses (Medicare Part A), most outpatient doctor visits (Medicare Part B) and many prescription drug costs (Medicare Part D), everyone who is on Medicare will still want to plan carefully for how to manage their additional out-of-pocket costs like coinsurance and deductibles or how to pay for other services that are not covered by the system.

Here's more about what Medicare covers and how to plan for your future health care costs.

 

 

Medicare Part A covers: Hospital costs

Medicare Part A covers hospital care and other types of short-term inpatient care. Hospital care can be expensive and is one of the most top-of-mind health care costs. People are often eager to have it covered by their insurance.

Medicare Part A generally covers

  • Hospital care (inpatient hospitalization) for a certain number of days. If you're hospitalized for longer than 60 days, you'll have to pay coinsurance for each additional day.
  • Skilled nursing facility care. Medicare Part A covers daily skilled nursing care for a limited time or short-term basis. You can receive care for up to 20 days without coinsurance. Medicare does not cover custodial "nursing home" care or long-term care.
  • Home health care. Medicare does not cover 24-hour home care, but it does cover part-time skilled nursing care delivered at your home, physical therapy, part-time home health aide care, occupational therapy, and other intermittent services in your home.
  • Hospice care. This service is for end-of-life care for people with a terminal illness and life expectancy of six months or less. Hospice also provides services and support for the patient's family during the end-of-life journey.

Learn more about Medicare Part A coverage Opens in new window.

 

Medicare Part B covers: Outpatient doctor visits

Medicare Part B Opens in new window is the other main part of Medicare. It generally covers care that happens outside the hospital or skilled nursing facility. Your regular doctor visits and medical checkups are the types of care covered by Medicare Part B.

Medicare Part B covers various preventive screenings, including flu shots, glaucoma tests, mammograms and screenings for other conditions like diabetes, cancer and cardiovascular disease. You also get a one-time "Welcome to Medicare" preventive doctor visit as well as annual "wellness" visits.

Learn more about Medicare Part B coverage Opens in new window.

 

Medicare Part D covers: Prescription drugs

Medicare Part D is an optional coverage type that is available to everyone with Medicare. It can help cover the costs of prescription drugs. It's hard to generalize about Medicare Part D because you have to choose your own drug plan, and there are many different plans depending on the insurance company and where you live.

Some drug plans cover different drugs, offer lower costs on certain generic drugs, or require higher levels of coinsurance for certain "tiers" of drugs. You can also get prescription drug coverage from a Medicare Advantage plan, but you’ll need to weigh your options carefully to understand which plan is right for you.

Learn more about Medicare Part D here Opens in new window.

 

What is not covered by Medicare?

Make sure you're aware of the various costs that are not covered by Medicare. In general, these services are not included with Medicare Parts A, B or D:

  • Nursing home care: Living in a nursing home for the long term and receiving help with daily life activities like eating, bathing and dressing are not covered by Medicare. If possible, you will want to consider purchasing long-term care insurance to help cover those costs.
  • Dental and vision care: Most dental care and regular eye exams are not covered by Medicare. Medicare Advantage plans can cover these extra services.
  • Hearing aids and exams for fitting them
  • Routine foot care

Learn more about what is not covered by Medicare Part A and B Opens in new window.

 

Medicare out-of-pocket costs

Even though Medicare provides great coverage for most of the biggest health care costs that seniors might face, it still requires premiums, deductibles and copays. Medigap plans can help cover these extra out-of-pocket costs.

Learn more about Medicare costs Opens in new window and Medicare Supplement Insurance (Medigap) Opens in new window.

Footnotes

Ben Gran is a freelance writer based in Des Moines, Iowa. He writes about personal finance, public policy, financial services, technology, and business.

 

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