Having a clear comprehension of the scope of coverage provided by Original Medicare is crucial. This understanding can enable Medicare beneficiaries to make well-informed choices regarding the other types of insurance plans they opt to enroll in.
Original Medicare Coverage
Part A and Part B make up Original Medicare, providing coverage for both inpatient and outpatient services. This includes hospital stays, medical equipment, doctor visits, lab tests, preventive services, and various other medical services.
Medicare Part A Benefits
Part A Benefits Include:
- A semi-private room
- Operating room
- Post-op recovery room
- Care in special units
- Hospital meals
- Lab tests
- Medications and equipment
- Rehabilitation services while and inpatient
- Blood transfusions
Medicare Part B Benefits
Part B provides coverage for numerous outpatient medical services, including preventive services such as cancer screenings, vaccines, and lab work, as well as mental health services and durable medical equipment. Additionally, while Part A covers hospital accommodations, Part B will also pay for services received during inpatient hospital care. This includes diagnostic images, surgeries, dialysis, chemotherapy, and medications administered through injection.
What is Not Included in Medicare Coverage?
Medicare coverage does not include long-term care, acupuncture, routine dental, vision, and hearing services, hearing aids, or cosmetic procedures.
Medicare Age Requirements
To enroll in Medicare, individuals must be at least 65 years old unless they have been receiving disability benefits for 24 months or have been diagnosed with ALS or ESRD.
Medicare Advantage Coverage
Medicare Advantage (Part C) plans, provided by private companies, offer an alternative to Original Medicare for health and drug coverage. These plans include Parts A, B, and usually D, and may offer extra benefits such as vision, hearing, and dental services. Medicare Advantage Plans must follow Medicare’s coverage rules and may have different out-of-pocket costs and service rules.
Part D Coverage
Medicare Part D, also known as the prescription drug benefit, covers most outpatient prescription drugs and is offered through private companies as a stand-alone plan for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. Part D has a formulary, or list of prescription medications it covers, and if a needed drug is not on the formulary, exceptions, out-of-pocket payments, or appeals may be necessary to obtain coverage.