What Medicare Really Covers

Many seniors or older adults most likely know about Medicare. Chances are good that they might even be covered by the program. However, even if you know a little about Medicare, it can be confusing trying to figure out exactly what is covered by Medicare and what isn’t. This article will discuss both Part A and Part B, and we’ll see what’s covered, and then take a look at what the program does not cover.

Before we get there, though, let’s see what the differences are between the two parts. Medicare Part A is known as Hospital Insurance, while Part B is Medical Insurance, and both A and/or B covers any eligible home health services, such as intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. However, in most cases, a home health care agency coordinates the services that your doctor orders for you.

In general, Medicare covers things like lab tests, surgeries, and visits to the doctor, as well as medically necessary supplies like wheelchairs and walkers. If you have a Medicare Advantage Plan or some other type of Medicare Plan, you might be subject to different rules, but it must afford you the same coverage as original Medicare at the very least. However, some services might only be covered in certain settings or for those patients who have certain conditions.

Now, let’s see some of the things that are covered by Part A specifically:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (so long as custodial care isn’t the only care required)
  • Hospice
  • Home health services

If you have any questions, be sure to consult your doctor or physician regarding any certain services or supplies you might need. If you are needing something that’s normally covered and the provider thinks Medicare might not cover it, you’ll need to read and sign a notice stating that you might have to pay for either the item, service, or supply. But you can also see if Medicare covers the item, service, or supply you need.

Let’s now move onto Part B. This part of Medicare covers services, such as lab tests, surgeries, and doctor visits, as well as supplies like wheelchairs and walkers, as we said above. Part B covers two types of services specifically. The first is medically necessary services, or those that are needed in order to diagnose or treat any medical conditions you have and that meet accepted standards of medical practice. The second type covered is Preventative services, such as health care to prevent illness or detect it at an early state, when the treatment will likely work best.

In general, you pay nothing for many of these preventative services if you receive them from a health care provider who accepts assignment.

Specifically, Part B covers likes like:

  • Clinical research
  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health (like inpatient, outpatient, or partial hospitalization)
  • Getting a second opinion prior to surgery
  • And finally, limited outpatient prescription drugs

While that is a lot of coverage, there are things that either part will not cover. Those things include the following:

  • Long-term care (also known as custodial care)
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • And routine foot care