New to Medicare Series: Part 6
What Original Medicare Covers
Original Medicare consists of two parts: Part A (hospital insurance) and Part B (medical insurance). This guide explores the types of services covered by Medicare Part A and Part B, and looks at some of the costs you can expect to pay for your Medicare coverage.
What Part A Covers
Some examples of the types of services covered by Medicare Part A include:
Inpatient hospital care
Medicare generally covers semi-private hospital rooms, general nursing, meals and other medically necessary hospital services and supplies.
Inpatient care in a skilled nursing facility
Medicare typically covers semi-private rooms, skilled nursing and rehabilitation services, meals and other medically necessary services and supplies after a 3-day minimum, inpatient hospital stay for a related illness or injury. Medicare does not cover inpatient care in a skilled nursing facility if custodial care is the only care needed.
Medicare covers hospice care for beneficiaries who are terminally ill. This coverage includes:
- Medical, nursing and social services
- Certain drugs
- Certain durable medical equipment
- All services needed for symptom management and pain relief
- Aide and homemaker services
Generally, a Medicare-approved hospice gives hospice care in your home or where you live, including a nursing home.
What Part B Covers
Medicare Part B helps cover some medically necessary doctor’s services, durable medical equipment, outpatient care, home health services, mental health services, preventive services and other medical services.
Below is a list of services that are typically covered by Medicare Part B. Services marked with an asterisk are considered preventive services.
Note: some terms and conditions may apply, so speak with your doctor and/or insurance provider for specific information about a service’s coverage.
- Abdominal aortic aneurysm screening*
- Advance care planning
- Alcohol misuse screening and counseling*
- Ambulance services
- Ambulatory surgical centers
- Bone density measurement*
- Breast cancer screenings*
- Cardiac rehabilitation
- Cardiovascular disease screenings*
- Cervical and vaginal cancer screenings*
- Chiropractic services (limited coverage)
- Chronic care management services
- Clinical research studies
- Colorectal cancer screenings *
- CPAP therapy
- Depression screening*
- Diabetes screenings*
- Diabetes self-management training*
- Diabetes supplies
- Doctor and other health care provider services
- Durable medical equipment
- Emergency department services
- Eyeglasses after cataract surgery (Original Medicare does not typically pay for vision care)
- Federally Qualified Health Center services
- Flu shots*
- Foot exams and treatment
- Glaucoma tests*
- Hearing and balance exams (Original Medicare does not cover hearing aids or exams for fitting hearing aids)
- Hepatitis B shots*
- Hepatitis C screening test*
- HIV screening*
- Home health services
- Kidney dialysis services and supplies
- Kidney disease education services
- Lab services
- Lung cancer screening*
- Medical nutrition therapy services
- Mental health care (outpatient)
- Obesity screening and counseling*
- Occupational therapy
- Outpatient hospital services
- Outpatient medical and surgical services
- Physical therapy
- Pneumococcal shot*
- Prostate cancer screenings*
- Prosthetic/orthotic items
- Pulmonary rehabilitation
- Rural Health Clinic services
- Second surgical opinions
- STD screening and counseling*
- Smoking and tobacco-use cessation*
- Speech-language pathology services
- Surgical dressing services
- Transitional care management services
- Urgently needed care
- “Welcome to Medicare” preventive visit*
- Yearly “Wellness” visit*
Enrolling in Medicare Part B is optional. If you have Medicare Part A and do not have Medicare Part B, Medicare will cover certain hospital costs, but will not cover routine doctor’s visits or other medical expenses.
What Original Medicare Doesn’t Cover
Although Original Medicare provides comprehensive coverage, it doesn’t cover everything. Some of the services that Original Medicare does not cover include:
- Long-term care
- Most dental care
- Most prescription drugs
- Cosmetic surgery
- Most vision care
- Hearing aids and exams for fitting them
- Custodial care
Some Medicare Advantage plans provide coverage that Original Medicare does not offer, such as prescription drug, vision, hearing and dental coverage. Speak with a licensed agent to find out which Medicare Advantage plans are available in your area.
Medicare Part A and Medicare Part B each come with their own out-of-pocket costs, including:
Your Medicare premium is what you pay each month for your Medicare coverage.
Most people do not pay a premium for Medicare Part A, provided they paid sufficient Medicare taxes while working. If you must pay a Part A premium, it may cost up to $437 a month in 2019.
The standard Part B premium in 2019 is $135.50 a month. This amount could be more based on your income.
Deductibles are what you must pay out of pocket before Medicare will pay its share for a covered service.
In 2019, the Part A deductible is $1,364 per benefit period.
A benefit period begins the day you’re admitted to the hospital and ends when you’ve been discharged for at least 60 days. If you’re admitted to the hospital after being discharged for 60 days, a new benefit period begins.
In 2019, the Part B deductible is $185 per year.
Coinsurance is the amount you pay for a covered service after your deductible is met. Coinsurance is usually a percentage (for example, 20%).
In 2019, the Medicare Part A coinsurance amounts are as follows:
- Days 1-60: $0 coinsurance per benefit period
- Days 61-90: $341 coinsurance per day of beach benefit period
- Days 91 and beyond: $682 coinsurance per each lifetime reserve day
- Beyond lifetime reserve days: all costs
The Part B coinsurance is typically 20% of the Medicare approved amount for services after your deductible is met.
For a more indepth look at your Medicare out-of-pocket expenses, read through our article, “Understanding Your Medicare Out-of-Pocket Costs.”
To learn more about Medicare, read through some of the other guides in this series or speak with a licensed insurance agent.
New to Medicare Series
Part 6: What Original Medicare Covers