What Does Medicare Cover?
What influences Medicare coverage
What your Medicare policy covers depends on what you choose to enroll in. For example, you can have Part A by itself, or you can have Part A in addition to Parts B and D.
Medicare Part C, also known as Medicare Advantage, is a special form of Medicare that will be discussed separately.
Roles of the Medicare Parts
Medicare consists of Parts A, B, C (also known as Medicare Advantage), and D. Each has its own purpose.
Medicare Part A will cover inpatient costs. These costs include:
- Hospital stays. This entails semi-private rooms, nursing care, and meals. How much Part A covers depends on how long you’re hospitalized. Benefit Period is the official term for this time, beginning on your first day of hospitalization and ending when you’re discharged. For days 1-60 of your stay, you pay the deductible, but no coinsurance. For days 61-90, you pay the coinsurance amount per day. For 91 days and beyond, you’ll have to dip into your Lifetime Reserve days and pay coinsurance for each day. You only get 60 Lifetime Reserve days in your lifetime.
- Hospice care. Here, Part A covers everything geared toward pain relief. You won’t have to pay anything for your pain medications except for a copay that may be as much as $5.
- Skilled Nursing Facility (SNF) care. You have to receive SNF for a minimum of three days before Medicare covers you. The benefit period here works differently from that of hospital stays. Medicare pays for everything for the first 20 days. Days 21-100 require daily coinsurance payments. You’ll have to pay every cost from day 101 onward.
- Home health, which encompasses professional medical treatments provided at home. You will need a professional to determine that your condition requires home confinement.
Part B covers what takes place outside the inpatient setting. These costs include:
- Preventative care. X-rays, cancer screenings, and vaccinations are included in this category
- Doctor visits
- Bone mass measurements
- Medical equipment like blood glucose monitors and CPAP machines
Part D covers prescription medications. Here is how this coverage works:
- It must cover at least two medications in each prescription category, which consists of immunosuppressants, anticancer, antidepressants, antipsychotics, HIV/AIDS medications, and anticonvulsants
- This list of approved medications is the formulary
- Medications not covered include barbiturates, benzodiazepines, and medications used for cosmetic reasons
- This policy must be joined separately
Medicare Advantage is a combination of Medicare Plans A, B, and D. It is unique in that:
- Medicare Advantage is sold via private insurance
- It covers dental, vision, and hearing. This alone can be a deciding factor, as Original Medicare does not offer dental, vision, and hearing coverage
- While Medicare Advantage is its own policy, you must be enrolled in Medicare Part B, too
- Medicare Advantage policies are legally required to offer you all of the benefits of Original Medicare, plus more
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