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Medicare Coverage By Topic

 

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Original Medicare is government-sponsored health insurance that includes Part A (hospital insurance) and Part B (medical insurance). It can be confusing to figure out which services Medicare covers, and which it doesn’t. Read more below to learn about the Medicare benefits you may be entitled to under Original Medicare.

 

Original Medicare — Part A

 

In general, Medicare Part A benefits include care you get as a hospital inpatient. For example:

  • Skilled nursing services
  • A semi-private room
  • Meals
  • Medications given to you as part of your inpatient treatment
  • Hospital services and supplies

Original Medicare - Part B

 

Medicare Part B covers many types of doctor visits and medical services. Please note that Medicare coverage applies only if certain conditions are met (for example, a service may have to be medically necessary and delivered in a Medicare-enrolled facility). Costs such as co-payments and deductibles may apply. This is not a complete list:

  • Preventive services, such as annual checkups (wellness) and vaccinations
  • Durable medical equipment (DME)
  • Mental health services
  • Ambulance services
  • Diabetic supplies
  • Second opinion prior to surgery

Some services may be covered under medicare Part A, Part B, or partially by both, depending on the situation. For example, cataract surgery may be outpatient surgery (covered by Part B) or inpatient surgery (covered by Part A).

What about Medicare Coverage When You're Not Yet 65, But You Have A Disability?

 

If you're eligible for Social Security or Railroad Retirement Board disability benefits, you might qualify for Medicare. Learn more about Medicare and disability, including when your Medicare benefits may start. 

 

Medicare Advantage (Medicare Part C)

 

There are some things Original Medicare doesn't cover, such as routine dental or vision services, or prescription drugs in most situations. Many Medicare Advantage (Medicare Part C) plans do offer such benefits. Medicare Advantage plans are offered by private insurance companies approved by Medicare, and must include at least as much coverage as Medicare Part A and Part B (except hospice services, which Medicare Part A covers even if you have a Medicare Advantage plan). Costs and availability of Medicare Part C plans vary, but you continue paying your Medicare Part C plans vary, but you continue paying your Medicare Part B premium when you're enrolled in a Medicare Advantage plan.