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What’s Covered by Medicare

What’s Covered by Medicare ?

Original Medicare comes in two parts ─ Part A and Part B. You only get these parts through the federal government. Everything else, like supplemental coverage, is built upon these core parts.

Part A: Hospital Insurance

Medicare Part A covers essential services such as your hospital room, meals, and various nursing and healthcare services. However, it’s essential to note that doctor services are covered under Part B, even when you’re in the hospital.

Medicare Part A covers:

  • Your hospital room and meals
  • Care in special units, including intensive care
  • Prescription drugs and medical supplies during an inpatient stay
  • Lab tests, X-rays, and medical equipment during inpatient care
  • Operating room and recovery room services
  • Skilled nursing services
  • Some blood transfusions
  • Hospice care, including medications for symptom management
  • Part-time, skilled care for homebound patients after a qualified inpatient stay
  • Rehabilitation services post-qualified inpatient stay

Medicare-qualified individuals cannot be denied Part A on the basis of health or financial status. If you or your spouse have worked and paid Social Security taxes for at least 40 quarters (10 years), there’s typically no premium. We’re going to keep it simple here, but there are lots of caveats when you get into the nitty-gritty details of the age of the working spouse, how long you’ve been married, and whether you’re divorced, widowed, or remarried.

There are some costs when using Part A benefits. As of 2024, these include:

  • a $1632 deductible for each benefit period (up to 60 days)
  • $408 per day for days 61-90
  • and $816 per lifetime reserve day (with a maximum of 60 days).

And, it’s critical to understand that there’s no maximum out-of-pocket limit with Part A.

Part B: Medical Insurance

As with Part A, you can’t be denied Part B coverage, regardless of your health or financial status. You also have the flexibility to see any provider in the country accepting Original Medicare.

Medicare Part B covers:

  • Doctor visits, even when you’re in the hospital
  • An annual Wellness Visit and preventive services
  • Clinical laboratory services, like blood and urine tests
  • Diagnostic tests, such as X-rays, MRIs, CT scans, and EKGs
  • Some health programs like smoking cessation and obesity counseling
  • Physical therapy, occupational therapy, and speech-language pathology services
  • Diabetes screenings, education, and specific supplies
  • Mental health care
  • Durable medical equipment for home use, like wheelchairs and walkers
  • Ambulatory surgery center services, ambulance, and emergency room services

Certain types of medications are also covered under Part B which a medical professional administers in a clinical or hospital setting. This includes chemotherapy or medications delivered via durable medical equipment such as insulin pumps or nebulizers. Diabetic supplies are also covered under Part B.

Part B comes with a monthly premium of $174.70 for most people in 2024, and it may be adjusted higher based on your household income. If you’re receiving Social Security or Railroad Retirement Board benefits, it’ll be deducted from your benefits check. There also can be a premium penalty for late enrollment. We’ll delve into enrollment a bit later.

There’s also a deductible of $240 per year (subject to annual changes). Don’t miss this ─ it’s your responsibility to cover 20% of Medicare-approved amounts for qualifying medical services, along with any Excess Charges, if they apply.

And just like Part A, it’s important to know that there’s no maximum out-of-pocket limit with Part B.

Original Medicare Doesn’t Cover Everything

We’ve talked about what Part A and Part B cover, but it’s essential to know that they don’t cover everything. You might be surprised to learn that you’ll have out-of-pocket costs, which could add up significantly depending on your healthcare needs.

Unfortunately, there’s no financial protection, and no out-of-pocket maximum, with Original Medicare, meaning a serious illness or injury could lead to financial stress.
Additionally, prescription drugs aren’t covered, and they can be a significant expense as we age. We’ll talk a lot about prescription drug coverage later.

  • Original Medicare (Parts A & B) does NOT cover:
  • Prescription drugs
  • Routine dental, vision, or hearing care
  • Eyeglasses, contacts, or hearing aids
  • Long-term care, such as residing in a nursing home
  • Custodial care, which includes bathing, eating, and dressing, is often referred to as Activities of Daily Living (ADL)
  • Excess charges for services by doctors who don’t accept Medicare assignment
  • Care received outside the United States, except in limited circumstances

The good news is that there are options to help with these non-covered items, and we’ll explore those.

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