Understanding Medicare: What’s Covered and What’s Not

Medicare health insurance goes a long way to pay for your health needs…but not all the way; be prepared in the event that you need extra coverage

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Conscious living and holistic self-care — so easy to say and so difficult to achieve. 

Our patience and continuous self-care practices for both body and mind help us become better versions of ourselves. Sometimes, however, we face health issues that require medical attention. Although self-care practices are of great importance, some medical conditions cannot be ignored and should be treated with the help of medical professionals. 

And that’s where the Medicare health plan comes in to play. Medicare is health insurance offered by the U.S. federal government for people aged 65 and over, and/or for people disabled, or with permanent kidney failure. Medicare is separated into 4 plans: A, B, C, and D. With so many different plans, it can be confusing which program offers the right coverage for you. 

Here’s an overview of each:

Medicare Part A

Also called ‘original Medicare’, this insurance plan covers hospital stays and services. Stays in skilled nursing homes facilities, walkers, hospice care, and wheelchairs are also included. If you can’t make it to the hospital, it can cover home healthcare as well. The cost of blood and blood transfusions, inpatient costs, and overnight stays can be included as well. 

An inpatient means that you’re formally admitted by a health care provider, while an outpatient is someone who receives hospital services without being checked into a hospital. This includes emergency services, surgery, X rays, and lab tests. It’s important to understand this distinction because it affects the coverage and the amount you might pay. 

Keep in mind that Part A will only cover a skilled nursing facility if you were admitted as an inpatient for three consecutive days in the hospital and have an admission order written by a doctor.

Medicare Part B

Also a part of ‘original Medicare’, this plan covers doctor services and preventive healthcare. Most Americans get Part A and Part B because it offers the most coverage. That would mean this:

If you’re checked into a hospital, the stay would be covered by A, whereas doctor services are covered by Part B.

Part B also covers a large number of tests like ambulance and emergency department services, influenza and hepatitis vaccines, screening for depression, cancer, and diabetes, medical equipment, electrocardiograms (EVGs), select drugs, diabetes supplies, and some prescriptions for eyewear.

Medicare Part C

Called ‘Medicare Advantage’, this is a supplemental plan that gives the customer additional coverage for an extra cost. You cannot purchase Part C without first having A and B because it’s a private insurance plan that fills in the gaps of what A and B don’t provide.

Prescription drugs, dental, and eye coverage are some of the benefits covered if you pay a premium to the doctors within your network. If not, co-payments and an additional fee may apply. The cost is fixed depending on what plan you choose.

Medicare Part D

Prescription drugs not covered by Part B, like infusions or injections, are covered under Part D.

This plan is optional, but many Americans have this plan so that all of their medications are covered.

The cost of this plan depends on what kind of drugs you take, the plans you have, and the pharmacy you choose. Normally you’ll pay a monthly premium, but the amount paid by the customer varies depending on income.

What’s best for you?

You can enroll in one or more parts of Medicare at the same time, but the most common combinations are A and B as these cover the majority of what the average citizen needs. However, if you are looking for more drug coverage, C and D can be purchased as an add on. For example, if you wanted to get the shingles vaccine, you would have to buy Part D. 

Although most medical services are covered by some combination of plans. But Medicare does not cover most dental care, hearing aids, acupuncture, eye exams, and cosmetic surgeries. Long-term care also won’t be covered, so if you have a family member who needs this, it’s better to look into an (LTC) insurance policy.

Before enrolling in Medicare, make sure to do your research in order to select the perfect plan for you and your family. If you have already enrolled and aren’t sure if a service is covered, refer to the Medicare website for complete details.

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