Figuring out what medicare covers can be a bit overwhelming and trying to find the correct information about each benefit can be confusing.
But did you know:
Figuring out everything that is covered is the best way to determine if you need additional coverage.
In this post today, I am going to go over all things covered by medicare from A to Z, and help you determine if you may need additional coverage.
Medicare Parts (A, B, C & D)
There are four different parts to medicare, also known as original medicare and they work like this:
Part A of Medicare is going to cover things like your stay in a skilled nursing facility to hospice care and blood transfusions.
It will also depend on your income if you will have to pay a monthly premium for your Part A coverage.
You may also have to pay co-payments or a deductible for any services under Medicare Part A.
Part B is also part of “original Medicare” and it will cover your doctor services, preventive healthcare, and testing services.
People often have Parts A and B together to get the most out of their coverage.
In 2019 the cost of Part B is going to be $135.50 per month and the annual part B deductible is going to be $185.00.
Part C of Medicare goes by the name of Medicare Advantage.
These plans, are supplemental plans that provide more coverage for an additional cost.
They are offered through private insurance companies and approved by Medicare.
Medicare Advantage plans fill in the gaps in services and hospital care. People with Medicare Part C must already be enrolled with Parts A and B.
These plans can also include prescription drug coverage or eye care.
If you are a person who takes lot’s of prescriptions then you are going to need Medicare Part D.
Part D is the plan that covers prescription drugs not covered by Part B, which are typically the kind of meds that need to be administered by a doctor, like an infusion or injection.
This plan is optional, but many people choose to have it so their medications are covered.
Just like Part C, these plans are offered through Medicare Approved private insurance companies and the rates will depend on the company and type of prescriptions you need.
You can check out the below video for a little more of an insight:
Quick Review Of What’s Not Covered
I want to go over a quick breakdown of the things that Medicare won’t cover.
It is essential to know how your plan will work overall.
Most dental care, eye exams, hearing aids, acupuncture, and any cosmetic surgeries are not covered by Medicare Parts A and B.
There also isn’t any coverage for long-term care, so if you think you need that kind of coverage you should be on the lookout for a separate policy.
Keep in mind that Medicare does not usually pay the full cost of your care, and you will likely be responsible for some portion of the cost-sharing (deductibles, co-insurance, co-pays) for Medicare-covered services.
A – Z Guide Of Things Covered
Abdominal aortic aneurysm screenings
Advance care planning
Airplane or Helicopter Transport
If you need medical attention faster than transport by ground transportation would allow, or if you’re in a location difficult for ground transportation to reach your transportation coverage will kick in.
Alcohol misuse screenings & counseling
Ambulance services: This is emergency transportation, typically to and from hospitals. Coverage for non-emergency ambulance/ambulette transportation is limited to situations in which there is no safe alternative transportation available, and where the transportation is medically necessary.
Ambulatory surgical centers
Artificial eyes & limbs
Behavioral health integration services
Blood processing & handling
Blood sugar monitors
Blood sugar test strips
Bone mass measurements
Braces (arm, leg, back, & neck)
Cardiac rehabilitation programs
Cardiovascular behavioral therapy
Cardiovascular disease screenings
Cervical & vaginal cancer screenings
Chronic care management services
Clinical laboratory tests
Clinical Research Studies designed to either diagnose or treat a specific illness. Medicare Part B benefits may include costs associated with medical services, new drugs and other experimental treatments, and monitoring for potential side effects.
Continuous passive motion devices
Continuous Positive Airway Pressure devices, accessories, & therapy
Counseling to prevent tobacco use & tobacco-caused disease
Diabetes prevention program
Diabetes self-management training
Diagnostic laboratory tests
Diagnostic non-laboratory tests
Dialysis services & supplies
Doctor & other health care provider services
Durable medical equipment (DME)
Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. You pay 20% coinsurance (plus up to 15% more if your home health agency does not take assignment).
EKG or ECG screenings
Emergency department services
Enteral nutrition supplies & equipment
Federally Qualified Health Center (FQHC) services
Foot care (for diabetes)
Glucose control solutions
Hearing & balance exams
Hepatitis B shots
Hepatitis B Virus infection screenings
Hepatitis C screening tests
Home Health Aid
Medicare pays in full for an aide if you require skilled care (skilled nursing or therapy services). A home health aide provides personal care services, including help with bathing, toileting, and dressing.
Home health services
Medicare covers services in your home if you are homebound and need skilled care. You are covered for up to 100 days of daily care or an unlimited amount of intermittent care. To qualify for Part A coverage, you must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care. (Note: You can get home health care through Medicare Part B if you do not meet all the requirements for Part A coverage.)
If you’re diagnosed with a terminal illness and your current treatments are not working or you decide that you no longer wish to pursue medical care, hospice care may be paid for under Medicare Part A. It can either be provided in your home or in a hospice facility.
Hyperbaric oxygen (HBO) therapy
Infusion pumps & supplies
Inpatient hospital care
This is care received after you are formally admitted into a hospital by a physician. You are covered for up to 90 days each benefit period in a general hospital, plus 60 lifetime reserve days. Medicare also covers up to 190 lifetime days in a Medicare-certified psychiatric hospital. Some of the inpatient expenses covered include: Meals, general nursing staff, medications used while in care, various other medical services and supplies used while in the hospital, and A semi-private room (unless a private room is deemed medically necessary)
Inpatient rehabilitation care
Kidney disease education
Kidney transplants (children)
Lancet devices & lancets
Lung cancer screenings
Macular degeneration tests & treatment
Medical social services
Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling or help finding resources in your community.
Medicare pays in full for certain medical supplies, such as wound dressings and catheters, when provided by a Medicare-certified home health agency (HHA).
Mental health care (inpatient)
Mental health care (outpatient)
Mental health care (partial hospitalization)
Mental Health Services (Overall)
Some things covered are Individual and group therapy Substance use disorder treatment Tests to make sure you are getting the right care Occupational therapy Activity therapies, such as art, dance, or music therapy Training and education (such as training on how to inject a needed medication or education about your condition) Family counseling to help with your treatment Laboratory tests Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you
Multi-Target Stool DNA Tests
Nebulizers & nebulizer medications
Nursing home care
Nutrition therapy services
Obesity behavioral therapy
Occupational therapy helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes.
Like rigid or semi-rigid leg, arm, back, and neck braces
Outpatient hospital services
Outpatient medical & surgical services & supplies
Oxygen equipment & accessories
Physical therapy includes gait training and supervision of and training for exercises to regain movement and strength in a body area.
Portable oxygen equipment
Pre-surgical second opinion
Not involving an emergency situation. For this piece of medical advice to be covered, the doctor providing the second opinion must accept Medicare.
Preventive services These are screenings and counseling intended to prevent illness, detect conditions, and keep you healthy. In most cases, preventive care is covered by Medicare with no coinsurance.
Prostate Cancer Screenings
Prosthetics, like artificial legs, arms, and eyes
Prosthetic devices, that replace bodily organs
Medically necessary services you receive from a licensed health professional.
Pulmonary rehabilitation programs
Religious non-medical health care institution items & services
Rural health clinic (RHC) services
Screening barium enemas
Screening fecal occult blood tests
Screening flexible sigmoidoscopies
Second surgical opinions
Sexually transmitted infections screenings & counseling
Skilled nursing facility (SNF) care
Medicare covers room, board, and a range of services provided in a SNF, including administration of medications, tube feedings, and wound care. You are covered for up to 100 days each benefit period if you qualify for coverage. To qualify, you must have spent at least three consecutive days as a hospital inpatient within 30 days of admission to the SNF, and need skilled nursing or therapy services.
Skilled nursing services Services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness. Services you may receive include: tube feedings catheter changes observation and assessment of your condition management and evaluation of your care plan, and wound care.
Skilled therapy services
Physical, speech, and occupational therapy services that are reasonable and necessary for treating your illness or injury, and performed by or under the supervision of a licensed therapist.
Speech-language pathology services include exercises to regain and strengthen speech and language skills.
Surgical dressing services
Swing bed services
Therapeutic continuous glucose monitors (CGMs)
Therapeutic shoes & inserts
These are outpatient physical, speech, and occupational therapy services provided by a Medicare-certified therapist.
Transitional Care Management Services
Medicare may cover these services if you’re returning to your community after a stay at certain facilities, like a hospital or skilled nursing facility. You’ll also be able to get an in-person office visit within 2 weeks of your return home.
Your costs in Original Medicare
You pay Coinsurance and the Part B Deductible.
Urgently needed care
Medicare Part B (Medical Insurance) covers urgently needed care to treat a sudden illness or injury that isn’t a Medical emergency.
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount for your doctor or other health care provider’s services, and the Part B Deductible applies. In a hospital outpatient setting, you also pay the hospital a Copayment.
Medicare Part B (Medical Insurance) covers walkers, including rollators, as durable medical equipment (DME). The walker must be Medically necessary and prescribed by your doctor or other treating provider for use in your home.
Your costs in Original Medicare
If your supplier accepts Assignment you pay 20% of the Medicare-approved amount, and the Part B Deductible applies. Medicare covers the cost for different kinds of DME in different ways. Depending on the type of equipment and qualifying diagnosis for a hospital bed:
- You may need to rent the equipment.
- You may need to buy the equipment.
- You may be able to choose whether to rent or buy the equipment.
“Welcome to Medicare” preventive visit
Medicare Part B (Medical Insurance) covers a “Welcome to Medicare” preventive visit once within the first 12 months you have Part B.
Your costs in Original Medicare
You pay nothing for the “Welcome to Medicare” preventive visit if your doctor or other qualified health care provider accepts Assignment. The Part B Deductible doesn’t apply.
However, you may have to pay Coinsurance, and the Part B deductible may apply if:
- Your doctor or other health care provider performs additional tests or services during the same visit.
- These additional tests or services aren’t covered under the preventive benefits.
Wheelchairs & scooters
Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home.
You must have a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps cover a power wheelchair. Power wheelchair coverage is provided only when Medically necessary.
X-rays and lab tests
Medicare Part B (Medical Insurance) covers Medically necessary diagnostic X-rays.
Your costs in Original Medicare
- You pay 20% of the Medicare-approved amount , and the Part B Deductible applies.
- If you get an X-ray in a Hospital outpatient setting , you pay a Copayment .
Yearly “Wellness” visits
This plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:
- A review of your medical and family history
- Developing or updating a list of current providers and prescriptions
- Height, weight, blood pressure, and other routine measurements.
- details about coverage for screenings, shots, and other preventive services
- A screening schedule (like a checklist) for appropriate preventive services
- A list of risk factors and treatment options for you
- Personalized health advice
- Detection of any cognitive impairment.
- Advance care planning
Now that you have a much stronger understanding of the things that Medicare will cover, you probably have realized that you are going to need additional overage.
This is where a Medigap or Medicare supplement plan will come into play.
These policies cover the gaps in coverage that medicare has missed.
Feel free to get a quote to the right or call us toll free at 1.800.924.4727 for assistance on getting covered.