Medicare Coverage

Grasping the scope of Original Medicare is crucial for beneficiaries to make well-informed decisions about additional insurance options.

Original Medicare Coverage Explained

Original Medicare, encompassing Part A and Part B, provides comprehensive coverage for various inpatient and outpatient medical services.

Benefits of Medicare Part A

Medicare Part A primarily covers hospital-related services, including:

  • Semi-private rooms
  • Operating and recovery rooms
  • Specialized care units
  • Hospital meals
  • Laboratory tests and X-rays
  • Medications and medical equipment during hospital stays
  • Rehabilitation services for inpatients
  • Blood transfusions
  • Hospice care
  • Skilled nursing facility care

Benefits of Medicare Part B

Part B focuses on outpatient medical services, offering coverage for:

  • Preventive services like cancer screenings and vaccines
  • Laboratory work
  • Mental health services
  • Durable medical equipment
  • Diagnostic imaging, surgeries, dialysis, chemotherapy, and injectable medications during hospital stays

What Does Original Medicare Not Cover?

Original Medicare does not cover long-term care, acupuncture, routine dental, vision, and hearing services, including hearing aids and cosmetic procedures.

Medicare Age and Eligibility Requirements

Individuals are eligible for Medicare at any age if they have been receiving disability benefits for 24 months or have ALS or ESRD diagnoses. Otherwise, eligibility starts at 65 years of age.

Medicare Advantage (Part C) Coverage

Medicare Advantage Plans, offered by private companies and approved by Medicare, provide an alternative to Original Medicare. These plans typically include Parts A, B, and often Part D coverage, and may offer additional benefits like vision, hearing, and dental services not covered by Original Medicare. Each Medicare Advantage Plan has different out-of-pocket costs and service rules but must adhere to Medicare’s coverage standards.

Part D Prescription Drug Coverage

Medicare Part D covers most outpatient prescription drugs and is available through private companies as either a standalone plan (for those with Original Medicare) or as part of a Medicare Advantage Plan. Part D plans have a formulary listing the covered prescription drugs. If a needed medication is not on the formulary, beneficiaries may request an exception, pay out-of-pocket, or file an appeal to ask the plan to reconsider its coverage decision.

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