When you are entering into Medicare, it can be confusing to decipher what Medicare covers versus the additional Medicare plans that you select. While Medicare covers many services, it doesn’t cover everything and many services require copays and/or coinsurance at the time of service.
Original Medicare consists of Medicare Part A and Medicare Part B only. In this blog, we will explore what Original Medicare covers and what it does not.
What is Covered under Medicare Part A?
Medicare Part A, also known as hospital insurance, covers hospitalization, skilled nursing care, hospice care, and some home health care. Part A is premium-free for most beneficiaries who have worked and paid Medicare taxes for at least 10 years. The following are some of the services covered by Medicare Part A:
- Inpatient hospital stays: Part A covers the cost of a semi-private room, meals, and other hospital services and supplies during an inpatient hospital stay. Copays for hospital stays are as follows for 2024:
- Days 1-60 – $1632 per benefit period
- Days 61-90 – $408 per day
- Days 90+ – $816 per day until lifetime reserve days are used
- Skilled nursing care: Part A covers up to 100 days of skilled nursing care in a Medicare-certified nursing facility. Copays for skilled nursing care are as follows for 2024:
- Days 1-20 – $0
- Days 21-100 – $204 per day
- Hospice care: Part A covers hospice care for individuals who have a terminal illness and choose to receive comfort care rather than curative treatment. Under Original Medicare, there is a $0 copay for hospice care in 2024.
- Home health care: Part A covers some home health care services for individuals who are homebound and need intermittent skilled nursing care or physical therapy. Under Original Medicare, there is a $0 copay for home health care in 2024.
There is no maximum out-of-pocket on Original Medicare Part A.
What is Covered under Medicare Part B?
Medicare Part B, also known as medical insurance, covers medical and health services, including doctor visits, laboratory tests, medical equipment, and other outpatient services. Part B is not premium-free and beneficiaries must pay a monthly premium. In 2024, the base premium for Medicare Part B is $174.70. The following are some of the services covered by Medicare Part B:
- Doctor visits: Part B covers doctor visits, including visits to specialists.
- Outpatient hospital services: Part B covers services such as diagnostic tests, laboratory services, and therapy services received in an outpatient setting.
- Durable medical equipment: Part B covers the rental or purchase of durable medical equipment such as wheelchairs, hospital beds, and oxygen equipment.
- Mental health services: Part B covers some mental health services such as individual and group therapy.
- Preventive services: Part B covers some preventive services such as yearly wellness visits and certain cancer screenings.
For all services under Part B, there is a yearly deductible of $240 (2024). Once the deductible is met, the beneficiary is responsible for 20% of the remaining costs. There is no maximum out-of-pocket on Original Medicare Part B.
What is Not Covered by Medicare?
While Medicare covers a wide variety of medical services, many services are not covered. The following are some of the services that are not covered by Medicare:
- Long-term care: Medicare does not cover long-term care services such as ongoing care in a nursing home or assisted living facility.
- Cosmetic surgery: Medicare does not cover cosmetic surgery unless it is medically necessary.
- Acupuncture: Medicare does not cover acupuncture.
- Routine foot care: Medicare does not cover routine foot care, such as the treatment of calluses or toenails.
- Chiropractic care: Medicare does not cover chiropractic care except for certain diagnoses.
- Hearing aids: Medicare does not cover hearing aids.
- Eyeglasses and contact lenses: Medicare does not cover the cost of eyeglasses or contact lenses.
- Dental services: Original Medicare does not cover routine dental services such as cleanings, fillings, extractions, dentures, or implants.
- Medicare care outside the United States: Original Medicare only covers care inside the United States.
- Prescription Drugs: Original Medicare does not cover prescription drugs. Prescription drugs are covered under Medicare Part D. You must obtain drug coverage through a Medicare Advantage plan or a stand-alone prescription drug plan.
Conclusion
In conclusion, Medicare is a comprehensive health insurance program that provides coverage for a wide range of healthcare services. However, it is important to understand what services are covered and what services are not covered to plan for potential out-of-pocket costs. Beneficiaries should also be aware of their options for additional coverage, such as Medicare supplements, Medicare Advantage plans or Medicare Part D plans, to help cover additional costs.
If you need more information about Medicare coverage, feel free to call us anytime at 615-919-1009 and our licensed agents would be happy to answer your questions.