Medicare FAQ: Medicare CoverageAugust 16th, 2013 | Posted by in Medicare Advantage | Medicare Coverage | Medicare Part D | Medicare Plans
There are many different parts to the Medicare program. In the third installment of our FAQ series, we will be looking at what each of the different parts of Medicare cover.
Medicare is broken into four main parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Beneficiaries also have the option of enrolling in a Medicare Supplement plan to fill in the gaps in Original Medicare coverage. In this post, we will discuss what each different part of the Medicare program covers.
What Medicare Part A covers
Medicare Part A, also referred to as hospital insurance, covers the costs of hospital, nursing home, home health, and Skilled Nursing Facility (SNF) care. Specifically, Part A covers:
- Inpatient hospital care: Covers semi-private rooms, general nursing, meals, and other hospital services and supplies. You pay $1,184 deductible for days 1-60, a $296 coinsurance per day for days 61-90, and a $592 coinsurance for days 91 and beyond.
- Skilled Nursing Facility (SNF) care: Covers skilled nursing care, semi-private rooms, meals, physical and occupational therapy, medications, dietary counseling. You pay $0 during days 1-20, $148 per day for days 21-100, and the full cost of services for days 100 and beyond.
- Nursing home care: Covers medically necessary skilled nursing care that provides more than custodial care (bathing, dressing, feeding, etc.). You pay $0 for days 1-20, up to $144,50 per day for days 21-100, and all costs after day 100.
- Hospice: Covers doctor services, nursing care, medical supplies and equipment, drugs for symptom control or pain relief, dietary counseling, and more.
- Home health services: Covers at-home health services such as physical therapy, intermittent skilled nursing care, and more.
What Medicare Part B covers
Medicare Part B, also referred to as medical insurance, generally covers medically necessary and preventive services. Specifically, Part B covers:
- Ambulance services: Covers emergency ground transportation to a hospital, Skilled Nursing Facility (SNF), or critical access hospital. You pay 20% of the Medicare-approved amount for these services.
- Durable medical equipment: Covers blood sugar monitors, air-fluidized beds, crutches, hospital beds, walkers, and more that your doctor prescribes as medically necessary.
- Mental health: Covers inpatient, outpatient, and partial hospitalization services.
- Getting a second opinion before surgery: Covers a second opinion on a non-emergency surgery or procedure.
What Medicare Advantage covers
Medicare Advantage plans are offered by private insurance companies and must offer at least the same coverage as Original Medicare, but may also offer additional benefits such as vision, dental, and prescription drug coverage. If you want a plan that covers additional benefits, be sure to compare plans available in your area to find one that meets your needs.
What Medicare Part D covers
Medicare Part D plans are offered by private insurance companies and offer coverage for prescription drugs. Each drug plan has its own formulary, or list of covered drugs, which is broken into tiers. These tiers determine how much you will pay for your prescription medications. Drugs in the lower tiers generally cost less than drugs in the higher tiers. To find a plan that covers your prescription medications, it is recommended that you shop around and compare drug formularies to find the right plan for your prescription drug needs.
What Medicare Supplement plans cover
Medicare Supplement plans fill in the gaps in coverage left behind by Original Medicare, including out-of-pocket costs such as copayments, coinsurance, and deductibles. There are ten standardized plans available to beneficiaries, and plans with the same letter offer the same benefits regardless of location and provider. Medicare Supplement plans cover the following general benefits:
- Part A coinsurance and hospital costs up to 365 days after Original Medicare benefits run out
- Part A hospice care copayment or coinsurance
- Part B coinsurance or copayment
- First three pints of blood used in a medical procedure
More comprehensive Medicare Supplement plans may also cover the following benefits:
- Part A deductible
- Part B deductible and excess charges
- Skilled Nursing Facility (SNF) care coinsurance
- Coverage outside of the United States
Because each part of Medicare offers different coverage, it is recommended that you shop around. PlanPrescriber offers a Medicare plan comparison tool that allows you to compare available plans in your area and find the right one for your individual needs.
Medicare hasn’t approved or endorsed this information.