What Does Medicare Insurance Cover?

When you are first eligible for Medicare, it can be confusing to navigate this new system. The first (and most important) question is: “What does your Medicare coverage actually pay for?”

Medicare is broken up into four parts. Most people enroll in Original Medicare (Part A and Part B). When you do this, you can count on your Medicare benefits through Medicare Parts A and B to cover the majority of services. Others may choose to enroll in Part C or Part D for an additional cost. Each of these Medicare plans will pay for different items and services.

What Does Medicare Part A Insurance Cover?

Medicare Part A (hospital insurance) is available to most Americans at the age of 65, as long as they are collecting retirement benefits from Social Security.

Medicare Part A offers health coverage in the following ways:

  • Home health care/home health services
  • Skilled nursing facility care
  • Inpatient hospital care/hospital stays
  • Hospice care
  • Inpatient care at a skilled nursing facility (not including custodial nursing home or long-term care)

What Does Medicare Part B Insurance Cover?

Medicare Part B (Medical Insurance) covers the medical services and supplies that are necessary to treat a health condition. It will also pay for some preventive services. If you are considered eligible for Part A, then you are also eligible for Part B. If you want to enjoy Medicare Part B coverage, you will have to pay a Medicare Part B premium. This monthly premium is the same for most people, although higher-income seniors do have to pay a higher amount.

Medicare Part B through the Medicare program will cover the following health care services:

  • Ambulance services
  • Durable medical equipment (DME)
  • Clinical research
  • Mental health (inpatient, outpatient, and partial hospitalization)
  • Outpatient care
  • Limited outpatient prescription drugs
  • Lab tests
  • Getting a second opinion prior to surgery

What Does Medicare Part C Insurance Cover?

Medicare Part C, also known as Medicare Advantage plans, describes private insurance policies approved by Medicare and the federal government. These policies offer additional coverage, such as dental, eye, and prescription drug coverage, for a higher cost. When you enroll in Medicare Part C, though, you can only visit doctors in your network. Comparing health insurance companies and insurance plans will help you find a plan with the right network coverage.

What Does Medicare Part D Insurance Cover?

Original Medicare only covers medications that are administered in a hospital setting, such as injections and infusions. Medicare Part D will help you pay for your regular prescription drugs. Keep in mind that you must pay more for this optional Medicare plan. It can help you reduce out-of-pocket costs for medication, however, so many people find that signing up for a prescription drug plan is worth it.

Will Medicare Cover the Cost of Walkers and Wheelchairs?

Yes! Medicare Part B will help to cover the cost of medically-necessary in-home medical equipment such as wheelchairs and walkers.

Does Medicare Cover Dental Procedures?

Original Medicare, Part A and B, will rarely pay for dental care. You may select a Medicare Advantage plan that covers dental services, purchase supplemental insurance, or pay these costs out of pocket.

What Does Medicare Insurance NOT Cover?

Unfortunately, the Medicare health insurance program does not cover everything. For example, Part A and Part B will not cover most dental care, hearing aids, eye exams, and cosmetic surgeries. Additionally, no Medicare plan will cover long-term care, so it may be wise to consider a separate long-term care insurance policy.

Why Do Some Seniors Choose a Medicare Supplement Plan?

Even when Medicare through the United States federal government does cover a medical service, you can still expect to pay for a copayment or deductible. That’s where Medigap plans come in. Medigap policies, or Medicare Supplement insurance, close the “gap” between what Medicare pays and what you owe. These plans cover various Medicare costs that are left behind. Find out if a Medigap plan is a good fit for your needs when you explore the My Medigap Plan website and check out our easy-to-use Medicare Supplement online quote tool. You can also check out medicare.gov for more information about Medicare and the health plans that you can sign up for.

Mark Prip

For more than two decades, Mark Prip at My Medigap Plans has been an authority figure in the insurance industry and continues to uphold a mission to provide customers with comprehensive information about Medicare, life, and dental coverage. In addition, his expertise is unmatched - having helped thousands of Medicare beneficiaries choose suitable healthcare plans for themselves - making him stand out above competitors.