Medicare covers services (like lab tests, surgeries, and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition. Medicare consists of four parts: Part A, Part B, Part C and Part D. Parts A and B are often referred to as “Original Medicare” since originally this was all that was offered. Medicare Parts A and B cover 80% of your medical costs. If you do not have other insurance, such as a supplement or an advantage plan, you will be responsible for the other 20%.
Medicare Part A
- Hospital care
- Skilled nursing facility care
- Nursing home care (as long as custodial care isn’t the only care you need)
- Home health services
Medicare Part B
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best. You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment. Part B covers things like:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health
- Partial hospitalization
- Getting a second opinion before surgery
- Limited outpatient prescription drugs
Medicare Part C
- If the plan charges a monthly premium.
- If the plan pays any of your monthly Medicare Part B premium.
- The plan’s yearly deductible or any additional deductibles.
- What you pay for each visit or service (copayment or coinsurance).
- The type of health care services you need and how often you get them.
- If you go to a doctor or supplier who accepts Medicare assignment
- If you follow the plan’s rules, like using network providers.
- If you need extra benefits and if the plan charges for it.
- The yearly limit on your out-of-pocket costs for medical services.