Concerned about healthcare coverage and costs as you age? Medicare has you covered! As the federal health insurance program designed to provide healthcare coverage to seniors aged 65 and older, as well as to those with certain disabilities, Medicare ensures affordable healthcare coverage through its various “parts” with set premium, deductible, and coinsurance rates.
But which parts cover which services? Will your current medical treatments and doctors still be covered under Medicare? Let’s look at some of the most common questions about what Medicare covers, so you can be sure you have the right healthcare coverage for you.
What Does Medicare Part A Cover?
Included in the federally administered Original Medicare, Medicare Part A is your hospital insurance. This provides inpatient hospitalization coverage, including hospital admittance, skilled nursing facility care, hospice care, and some home health care services. If you worked and paid Medicare payroll taxes for ten or more years, your Part A coverage is premium free. However, Part A coverage does come with an inpatient hospital deductible.
What Does Medicare Part B Cover?
Included in the federally administered Original Medicare, Medicare Part B is your medical insurance. This covers typical healthcare services with any clinic, doctor, or provider within the U.S. who accepts Medicare. Part B coverage includes preventive care and screenings, doctor visits, lab work, outpatient and ambulatory services, and durable medical equipment. It also covers some in-patient services that Part A doesn’t cover, like some home health care, physical and occupational therapists, and mental health services (inpatient and outpatient), as well as partial hospitalization. Your Part B coverage pays 80% of healthcare costs and you pay 20%, with the Part B premium, deductible, and coinsurance rates set annually, based on income according to the Social Security Act.
What Does Medicare Part C Cover?
Medicare Part C is better known as Medicare Advantage—Medicare plans offered and managed by private insurance companies approved by Medicare to administer your benefits and coordinate your healthcare services. Medicare Advantage Plans provide Part A and B coverage, but usually also include prescription drug coverage (Medicare Part D), as well as additional benefit coverage, like dental, hearing, vision, wellness and fitness programs. These private plans often have a set network of providers you choose from, with higher rates for out-of-network providers and can also have different cost-sharing requirements and premiums (beyond the Medicare Part B premium) based on the coverage and features of the plan.
What Does Medicare Part D Cover?
Medicare Part D provides prescription drug coverage. All Medicare Part D plans are offered by private insurance companies and supplemented by Medicare, as Part D is not included in Original Medicare. Prescription drug coverage is included if you choose a privately insured Medicare Advantage Plan, or you can choose to add a Part D plan if you enroll in Original Medicare. All Part D plans have formularies listing the drugs covered and at what tier, determining your out-of-pocket costs. You’ll want to review and compare plan formularies, tier structures, and costs to ensure any medications you’re taking are covered at the lowest cost to you.
Does Medicare Cover Preventive Health Services?
Yes, Medicare Part B covers preventive care and services, most at 100%. This includes preventive tests and screenings, doctor wellness visits and exams, shots and vaccinations, and even therapy, counseling and mental health services. You can see the complete list of preventive care and screening services covered by Medicare at Medicare.gov.
Does Medicare Cover Home Health Care?
Yes, Medicare covers home health care services under certain conditions and with restrictions. You must be under a plan of care by a doctor who certifies you are homebound and in need of (and prescribes) skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy. Medicare then covers 100% of these home health care services, as well as home health aide services, medical social services, and medical supplies and durable medical equipment for use at home. Additionally, many Medicare Advantage Plans and Special Needs Plans now offer expanded Primarily Health-Related Supplemental Benefits that include various in-home support services, home-based palliative care, and support for a Medicare beneficiary’s caregivers.
Does Medicare Cover Nursing Homes?
Medicare Part A covers hospice care and skilled nursing facility care due to a qualifying hospital stay and/or with a doctor’s certification for daily skilled nursing care. Medicare does not cover “custodial care” – the long-term care provided by assisted living homes for individuals who can no longer live on their own, like help with bathing, dressing, and other daily living activities.
Does Medicare Cover Physical Therapy?
Yes, Medicare fully covers physical therapy services under both Parts A and B. Medicare Part A covers inpatient physical therapy as part of a hospital stay, home health care services, and/or skilled nursing facility care. Medicare Part B covers outpatient physical therapy through a doctor’s office, physical therapy clinic, hospital outpatient department, and/or home physical therapy if prescribed by a doctor as medically necessary.
Does Medicare Cover Ambulance?
Yes, ambulatory services are covered under Medicare Part B. This includes emergency ground transportation to a hospital, critical access hospital, or skilled nursing facility. Medicare may also cover non-emergency ambulance services if you have a written order from your doctor stating that it is medically necessary. You’ll pay 20% of the Medicare-approved amount after meeting the yearly Part B deductible.
Does Medicare Cover Wheelchairs?
Yes, Medicare covers wheelchairs under certain conditions and with restrictions. A manual wheelchair is covered under Medicare Part B as durable medical equipment if your doctor deems the wheelchair medically necessary and prescribes it for use in your home. Medicare also covers power wheelchairs and scooters with face-to-face examination and written order from your doctor. Typically, Medicare covers 80% of the Medicare-approved amount for wheelchairs from Medicare-enrolled suppliers, and you are responsible for the remaining 20% after meeting the yearly Part B deductible.
Does Medicare Cover Dental?
No, Original Medicare (Part A and Part B) does not include or offer dental coverage. If you elect Original Medicare for your coverage, you can buy a stand-alone dental plan from a private insurer, similar to how you buy a Part D prescription drug plan. However, many Medicare Advantage Plans (Part C) offer dental coverage as part of their additional benefits. If you want dental coverage, you can choose to add a private dental plan if you enroll in Original Medicare or consider Medicare Part C and compare individual Medicare Advantage Plans for their dental benefits and coverage options.
Does Medicare Cover Hearing Aids?
No, Original Medicare (Part A and Part B) does not cover hearing aids or exams for fitting them. However, some Medicare Advantage Plans (Part C) offer coverage for hearing exams, hearing aids, and related services as part of their additional benefits. If you need hearing coverage, you’ll want to consider Medicare Part C and compare individual Medicare Advantage Plans for their specific benefits and coverage options.
Does Medicare Cover Eye Exams?
No, Original Medicare (Part A and Part B) does not cover routine eye exams for vision correction. However, Medicare Part B does cover eye exams related to specific conditions, including glaucoma, macular degeneration, and diabetic retinopathy. Many Medicare Advantage Plans (Part C) offer vision coverage for eye exams, glasses, and related services as part of their additional benefits. If you need vision coverage, you’ll want to consider Medicare Part C and compare individual Medicare Advantage Plans for their specific benefits and coverage options.
Does Medicare Cover Glasses?
No, Original Medicare (Part A and Part B) does not cover glasses or contact lenses for vision correction. However, Medicare Part B does provide coverage for one pair of eyeglasses or contact lenses due to cataract surgery with an intraocular lens implant. Many Medicare Advantage Plans (Part C) offer vision coverage for eye exams, glasses, and related services as part of their additional benefits. If you need vision coverage for glasses, you’ll want to consider Medicare Part C and compare individual Medicare Advantage Plans for their specific benefits and coverage options.
Does Medicare Cover Cataract Surgery?
Yes, Medicare Part B covers 80% of the costs associated with cataract surgery, as well as one pair of eyeglasses or contact lenses needed due to the surgery. You’ll pay 20% of the Medicare-approved amount for the procedure after meeting the yearly Part B deductible.
Does Medicare Cover Chiropractic?
Yes, Medicare covers chiropractic care under certain conditions and with restrictions. Medicare Part B covers only medically necessary manual spine manipulation to correct a subluxation, which is when one or more of the bones of your spine move out of position. There are no limits on the number of visits covered. You’ll pay 20% of the Medicare-approved amount after meeting the yearly Part B deductible. Medicare does not cover other chiropractic services or tests ordered by a chiropractor, such as X-rays or massage therapy.
Does Medicare Cover Acupuncture?
Yes, under certain conditions and with restrictions. Medicare covers acupuncture only for the treatment of chronic low back pain. Medicare Part B covers up to 12 acupuncture visits in 90 days, with an additional eight sessions if the acupuncture treatments improve your lower back pain. You’ll pay 20% of the Medicare-approved amount after meeting the yearly Part B deductible. Medicare does not cover acupuncture treatments for any other conditions.
Does Medicare Cover Gym Membership?
No, Original Medicare (Part A and Part B) does not cover gym memberships or fitness programs. However, some Medicare Advantage Plans (Part C) offer gym memberships or senior fitness programs like SilverSneakers as part of their additional benefits. If you want coverage for gyms and fitness programs, you’ll want to consider Medicare Part C and compare individual Medicare Advantage Plans for their specific benefits and coverage options.
More Questions about Medicare coverage? Wandacare has you covered! Our team of experts can help you navigate and compare all the Medicare parts, benefits, and coverage options to ensure you have the perfect plan for you.
