What Does Medicare Cover?

Medicare is a health care insurance plan sponsored by the US government. It is provided to 65-year-old or older US citizens or non-citizens who have been permanent legal residents for more than five consecutive years.

Also eligible are the disabled and those with specified conditions, including amyotrophic lateral sclerosis (Lou Gehrig’s disease) and end-stage renal disease (ESRD). Basic Medicare, also referred to as Original Medicare, includes hospital insurance (Medicare Part A) and medical insurance (Medicare Part B).

What Does Medicare Cover?

In health insurance, coverage refers to the health care services that an insurance plan pays for in part or in full, under specified conditions. In general, the health care services that Medicare covers must be delivered by a provider assigned by Medicare in a facility enrolled in the Medicare network.

Original Medicare provides Medicare Part A, which covers hospital insurance, and Medicare Part B, which covers medical insurance. Hospital insurance pays for services such as skilled nursing care, inpatient hospital care, hospice services, and certain home health care services. Medical insurance pays for services such as mental health services, outpatient care, doctor visits, lab tests, preventive screening, and durable medical equipment.

What Options Are Available for Medicare?

Medicare offers a number of options. Original Medicare is the most basic option, offering only Medicare Part A and Medicare Part B. Medicare Part A is available at no monthly fee, provided you have worked for 40 quarters or 10 years and have been paying Medicare taxes the entire time.

To obtain Medicare Part B (Medicare Advantage), you will typically be required to pay premiums on a monthly basis. However, you can opt out of it if, for example, your employer provides group health coverage. Later on, when the group coverage expires or you retire, you can enroll for Medicare Part B.

Note that out-of-pocket costs accompany Original Medicare. Deductibles feature in Medicare Part A and Medicare Part B. Some coverage limits, copayments and coinsurance are also common with Original Medicare.

Other Medicare plans are the Medicare Advantage (Medicare Part C) and Medicare Supplement. To be eligible for either, you are required to be enrolled in Medicare Part B. It is important to note that failure to enroll for Medicare Part B soon enough may result in a late-enrolment penalty throughout your coverage period, unless you are eligible for the Special Enrolment Period.

There are situations in which prescription drugs are not covered by Original Medicare. In such as case, you can purchase a Medigap (Medicare Supplement) plan that will help offset the out-of-pocket costs of Original Medicare. Alternatively, you can buy a separate prescription drug plan (Medicare Part D) from Medicare-approved private insurance companies.

Rather than getting Medicare Part A and Medicare Part B directly from the government, you can choose to get these through a Medicare Advantage plan. Additional benefits in the Medicare Advantage plan include routine dental and vision care. Note than while under the Medicare Advantage plan, Medicare Part A will still cover hospice care.

Needless to say, it is important to take your time to examine your health insurance needs and your budget in order to select the most suitable Medicare plan.