What Does Medicare Cover

What Does Medicare Cover?

Medicare is known for its broad scope in coverage. However, the coverage depends on the individual Parts, which have to be purchased separately. This will provide a deeper look into what each Medicare Part covers.

Interested in learning more?

What it takes to get Medicare coverage

Before Medicare can cover you, you must:

Be at least 65 years old
Or, receive disability benefits for at least 24 months

You also have to pay premiums, deductibles, copays, and coinsurance costs. All of these Medicare Parts are optional, so this is all discussed assuming you have all of the Medicare Parts mentioned here.

Medicare Part A

Medicare Part A addresses the costs incurred in the inpatient setting. That applies to the hospital, hospice, mental health facilities, and skilled nursing facilities.

The costs covered include your room and board, as well as the meals, medications, and all blood supplied to you after the first three pints. If in hospice, Part A coverage is directed at pain management in all forms – physical, emotional, and spiritual. Hospice coverage also includes homemaker services.

Part B

Part B handles outpatient treatment costs. Coverage begins as soon as you pay the annual deductible, which is $203 in 2021. Medicare Part B works based on an approved amount. Medicare approves a certain amount when you get outpatient medical treatment, and it pays 80% of that, leaving you 20% of that amount to pay out-of-pocket.

Here, Part B will help you pay for mental health treatments, durable medical equipment (e.g. insulin pumps), and preventive services such as x-rays, exams, and chemotherapy.

Another thing to consider is first checking with your provider to ensure that they accept Medicare. Some doctors may allow for Medicare to cover your treatment costs, but they themselves do not accept Medicare assignment. So, your out-of-pocket costs here will include that 20% of the Medicare-approved amount, and additional charges from your doctor – these are known as excess charges.

Part C (Medicare Advantage)

Medicare Advantage is a composite of all of the other Medicare Parts. It stands on its own because it’s sold via private insurance. A Medicare Advantage plan is legally required to offer all of the benefits one would get with Medicare Parts A, B, and D themselves, with additional benefits such as gym memberships, dental care, hearing treatments, and eyecare services.

In other words, Medicare Advantage gives you:

Hospital service coverage such as surgeries, room and board, and meals
Preventive care and x-rays, exams, and durable medical equipment
Prescription drug coverage, making your medications more inexpensive than ever before

Part D

Part D covers prescription medications and assigns costs according to what tier they fall under in your plan’s formulary. Your insurance company will work with you and your prescriber to help you find the lowest-cost medication that suits your needs.

What Medicare can do for you

Medicare With Jake brings you great coverage right from our office in Wichita, Kansas. At Medicare With Jake, we have a vision for your future – one where you can get everything you need at the lowest possible cost. Hospital stays, doctor visits, and prescriptions can be more affordable than ever before. And all it takes is one phone call.