What are the parts of Medicare? And what do they cover?
Here are some basic facts to get you started learning about Medicare and what it covers.
When I first started my career in the Medicare world, I realized there was a lot of new information I had to learn. I found that breaking it down into bite-sized pieces made it easier to understand. I started by focusing on all the different parts of Medicare. Here are some tips that helped me understand the parts of Medicare and what they cover.
What is Medicare?
Medicare is a federal health insurance program. You can get Medicare if you’re age 65 and older. You can also get Medicare at age 18 or older if you’re disabled or have end-stage renal disease. The Medicare program offers basic coverage to help pay for things like doctor visits, hospital stays and surgeries.
What are the parts of Medicare?
Medicare is broken out into four parts.
- Medicare Part A
- Medicare Part B
- Medicare Part C
- Medicare Part D
What does Medicare cover?
The parts of Medicare cover different services:
Medicare Part A
Part A (hospital coverage) covers things like inpatient hospital stays, some home health care and skilled nursing facility care. Together, Medicare Parts A and B are called “Original Medicare.”
Medicare Part B
Part B (medical coverage) covers things like doctor visits, outpatient services, X-rays and lab tests, and preventive screenings.
Medicare Part C
Part C is also known as Medicare Advantage. Private health insurance companies offer these plans. When you join a Medicare Advantage plan, you still have Medicare. The difference is the plan covers and pays for your services instead of Original Medicare. These plans must provide the same coverage as Original Medicare (so you’re not missing out on anything). They can also offer extra benefits.
Medicare Part D
Part D covers prescription drugs. Only private health plans offer it. You can get a separate Part D plan or sometimes it’s included in a Medicare Advantage plan.
Does Medicare cover these services?
Here’s general info about what Medicare does or doesn’t cover for common health care needs. Visit medicare.gov/coverage for more detail. Also, check a Medicare Advantage plan’s Summary of Benefits to learn what’s covered.
Medicare doesn’t cover acupuncture. Some Medicare Advantage plans have benefits that help pay for acupuncture services.
Assisted living is housing where people get help with daily activities like personal care or housekeeping. Medicare doesn’t cover costs to live in an assisted living facility or a nursing home.
Medicare Part A may cover care in a skilled nursing facility if it is medically necessary. This is usually short term for recovery from an illness or injury.
The federal Medicaid program can help pay costs for nursing homes or services to help with daily living activities.
Medicare Part B covers outpatient surgery to correct cataracts. It also pays for one pair of standard frame eyeglasses or contact lenses as needed after the surgery.
Medicare has some coverage for chiropractic care if it’s medically necessary. Part B covers a chiropractor’s manual alignment of the spine when one or more bones are out of position. Medicare doesn’t cover other chiropractic tests or services like X-rays, massage therapy or acupuncture.
Some Medicare Advantage plans have benefits that help pay for these other chiropractic tests or services.
Medicare covers screening colonoscopies. Test frequency depends on your risk for colorectal cancer:
- Once every 24 months if you have a high risk
- Once every 10 years if you aren’t at high risk
If you had a different screening for colorectal cancer called a flexible sigmoidoscopy, Medicare covers a screening colonoscopy if it is 48 months or longer after that test.
Medicare doesn’t cover routine eye exams to check your vision if you wear eyeglasses or contacts. It does cover eye exams if you have diabetes or other medical conditions like glaucoma or cataracts.
Some Medicare Advantage plans have benefits that help pay for routine eye exams.
Medicare generally doesn’t cover eyeglasses or contact lenses. Part B does pay for eyeglasses or contact lenses if you need them after cataract surgery.
Some Medicare Advantage plans have benefits that help pay for eyeglasses and/or contact lenses you need to correct your vision.
Medicare doesn’t cover hearing aids or pay for exams to fit hearing aids. Some Medicare Advantage plans have benefits that help pay for hearing aids and fitting exams.
Medicare Part A and Part B cover some home health services if you meet certain conditions. Covered services include:
- Skilled nursing care or home health aide services that are part-time or occasional (intermittent)
- Physical, occupational or speech therapy
- Medical social services
Medicare doesn’t cover 24-hour home care, delivered meals, homemaker services, or personal care. Some Medicare Advantage plans have benefits that help pay for the home health care services Medicare doesn’t cover.
Medicare Part A covers hospice care for terminally ill patients who will live six months or less. Patients agree to receive services that focus on providing comfort and that replace the Medicare benefits to treat an illness.
When can I get Medicare?
There are a few different times you can enroll throughout the year. These are called enrollment periods.
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WANT TO KEEP LEARNING HOW MEDICARE WORKS?
Check out this introduction to Medicare basics video.