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What Medicare covers, and what it doesn't

Just like regular health insurance, Medicare doesn’t cover absolutely everything having to do with healthcare. Having simple Medicare Part A and Part B with a Part D prescription drug plan can allow for some gaps in coverage, leaving members with co-pays or bills.

To put it clearly, there are actually 4 types of Medicare plans:


  1. Medicare Part A – hospital insurance. This covers inpatient hospitalization, lab tests, surgical needs, nursing homes, hospice, and home health aides.

  2. Medicare Part B – Medical insurance. This covers doctor’s visits, outpatient services, certain medical equipment, home health care, and some preventive services.

  3. Medicare Part C – Medicare Advantage. A health plan choice that’s offered by private companies approved by Medicare, Medicare Advantage includes both Part A and Part B coverage. Benefits such as hearing, dental, and vision are often included in these plans as well. Additionally, Part C plans will provide coverage for Part D prescription drug plans, too. The most common of these plans are referred to as a Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) plan.

  4. Medicare Part D – prescription drug plans. This is where coverage for drugs prescribed by a doctor comes into play. Medicare sets a standard level of coverage for Medicare Part D drug plans. Prescription drugs are placed into different “tiers,” depending on the particular Medicare Part D plan. The plans can vary in the drugs that they cover, called a formulary, which is provided by the insurance company.


Now that what Medicare Part A and Part B do cover is clear, what do they not cover?

  • Long-term care

  • Most dental work and dentures

  • Eye exams and eyeglasses

  • Cosmetic surgery

  • Acupuncture

  • Hearing aids and the exams to fit them

  • Podiatry

  • Healthcare outside the US (except when you’re on a cruise ship within six hours from a US port)


Beneficiaries will also be responsible for any deductibles and co-payments, since Part B only covers 80% of medical services. According to the Center for Medicare Services (CMS), the Medicare Part A deductible for 2020 is $1,408, and the annual deductible for all Medicare Part B beneficiaries is $198 in 2020. Seniors will be responsible for the other 20% of fees that aren’t covered under A and B.


To fill these gaps in coverage and avoid getting any unexpected health bills, seniors should consider opting into a Medicare Supplement or Medicare Advantage plan.The Rose Boys at Diversified have licensed representatives specializing in Medicare Advantage who are just waiting to help figure out exactly what you are entitled to, at no cost at all!


Call today to get a free Medicare benefit check-up at 1-844-244-8000!

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