What Medicare Covers
A common question I hear people asking is…
“What Does Medicare Cover?”
Medicare covers certain medical services and supplies in hospitals, doctors’ offices, and other health care settings. Services are either covered under Part A (hospital) or Part B (medical).
If you have both Part A and Part B, you can get all the Medicare-covered services listed in this article whether you have Original Medicare or a Medicare health plan (Medicare Advantage Plan).
If you are in a Medicare Advantage Plan and you go to a Medicare provider that doesn’t belong to your plan, your services may not be covered, or your costs could be higher depending upon the type of Medicare Advantage Plan that you are enrolled in.
Medicare Part A (Hospital Insurance) helps cover the following:
-INPATIENT CARE IN HOSPITALS:
Coverage includes a semi-private room, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies.
Coverage does not include private-duty nursing, a television or telephone in your room (if there is a separate charge for those items), or personal care items like razors or slipper socks. It also does not include a private room, unless medically necessary. If you have Part B, it covers the doctor’s services you get while you are in the hospital.
-INPATIENT CARE IN A SKILLED NURSING FACILITY (not custodial or long-term care): Coverage includes semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies that are medically necessary after a 3-day minimum inpatient hospital stay for a related illness or injury.
To qualify for care in a skilled nursing facility, your doctor must certify that you need daily skilled care like intravenous injections or physical therapy. Medicare does not cover long-term care or custodial care.
-HOSPICE CARE SERVICES:
Hospice is for people who are doctor certified to live 6 months or less.
Coverage includes drugs for pain relief and symptom management; medical, nursing, and social services; certain durable medical equipment and other covered services as well as services Medicare usually doesn’t cover, such as spiritual and grief counseling.
A Medicare-approved hospice usually gives hospice care in your home or other facility where you live like a nursing home.
Hospice care doesn’t pay for your stay in a facility (room and board) unless the hospice medical team determines that you need short-term inpatient stays for pain and symptom management that cannot be addressed at home. These stays must be in a Medicare-approved facility such as a hospice facility, hospital or skilled nursing facility which contracts with hospice.
-HOME HEALTH CARE SERVICES:
This coverage is limited to medically-necessary part-time or intermittent skilled nursing care, or physical therapy, speech-language pathology, or a continuing need for occupational therapy.
A doctor or other health care provider enrolled in Medicare must order your care, and a Medicare-certified home health agency must provide the care. You must be home-bound, which means that leaving home is a major effort.
-INPATIENT CARE IN A RELIGIOUS NON-MEDICAL HEALTH CARE INSTITUTION:
Medicare will only cover the non-medical, non-religious health care items and services (like room and board) in this type of facility for people who qualify for hospital or skilled nursing facility care, but for whom medical care isn’t in agreement with their religious beliefs.
Out of pocket costs for Part A services may include Medicare deductibles, co-payments, and co-insurance. These costs would vary depending upon the type of Medicare supplement or Medicare Advantage plan that you choose.
Medicare Part B (Medical Insurance) helps cover medically-necessary services.
Part B helps cover doctor services and tests, outpatient care, home health services, durable medical equipment, and other medical services including some preventive services.
Under Original Medicare, if the Part B deductible applies, you must pay all costs until you meet the yearly Part B deductible before Medicare begins to pay its share. Then, after your deductible is met, you typically pay 20% of the Medicare-approved amount of the service.
Medicare doesn’t cover everything. Even if Medicare covers a service or item, you generally have to pay deductibles, co-insurance, and co-payments. Some of the items and services that Medicare does not cover include the following:
- Long-term care
- Routine dental care
- Cosmetic surgery
- Hearing aids
- Exams for fitting hearing aids