What Medicare Covers

Original Medicare covers a range of medical services and supplies in hospitals, doctors’ offices, clinics and other health care settings. Services are either covered under Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). Here’s a quick look at what Medicare covers under each part:

What Medicare covers – Part A

• Inpatient hospital care
• Skilled nursing facility care for inpatient skilled nursing and rehabilitative services
• Inpatient Hospice Care
• Religious nonmedical health care institution (Inpatient)

What Medicare covers – Part B

• Doctors’ services (including office visits)
• Preventive care such as bone density test and mammogram
• Durable medical equipment
• X-rays, MRIs, EKGs
• Physical Therapy
• Ambulance and Emergency Room

What expenses do you have to pay with Medicare?

Medicare has deductibles and copayments, which are also called out-of-pocket expenses. These are the costs you are responsible for paying — either on your own or with supplemental insurance.

OPTIONAL PLANS TO HELP OFFSET OUT-OF-POCKET COSTS

Medicare Supplement

Medicare Supplement insurance is designed to work with Original Medicare, to help pay costs that Original Medicare doesn’t cover. This coverage:

• Helps to pay Original Medicare’s deductibles and copayments.
• Gives you the freedom to choose your own Medicare-participating doctor — with no referrals needed for specialist care.
• Is “standardized“ by the federal government — which means the benefits for each plan do not vary from one company to another. Price and service, however, may vary greatly from company to company.
• Does not cover prescription drugs.

Medicare Advantage (Part C)

Medicare Advantage plans are partially funded by the federal government to help keep your costs low. Instead of supplementing Medicare to pay what Medicare doesn’t, it is a substitute for Original Medicare, providing all of your benefits in one plan. These plans:

• Provide more coverage than Original Medicare, to help lower out-of-pocket costs.
• May include medical coverage and Medicare-approved prescription drug coverage.
• Feature predictable copayments, so you’ll always know what you’ll pay for visits to the doctor.
• Provide coverage with lower out-of-pocket costs when you use the plan’s specific network of doctors, hospitals and other health care providers.

Medicare Prescription Drug Plan (Part D)

A Medicare-approved Prescription Drug Plan (PDP) (also referred to as Part D) may be sold separately and is available from private insurance companies. These plans:

• Provide benefits that help to reduce your prescription drug costs.
• Typically cover both brand-name and generic drugs.
• Provide prescription drug coverage if you have Original Medicare or Original Medicare and a Medicare Supplement plan. (For information about covered benefits, limitations and exclusions, please see your coverage documents, as well as www.medicare.gov.) May be part of Medicare Advantage plans.