Helping you find the right Medicare coverage today!

There are four different parts to Medicare which cover certain services for people who qualify: hospital insurance (Part A), medical insurance (Part B), the Medicare Advantage program (Part C), and prescription drug coverage (Part D). Those who qualify can opt for coverage through the Original Medicare program or through private insurance companies (such as Medicare Advantage).

Medicare Part A

Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care. You must meet certain conditions.

Medicare Part A Helps Cover:

Hospital Stays: Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes care you get in critical access hospitals and inpatient mental health care. This does not include private duty nursing or a television or telephone in your room. It also does not include a private room, unless medically necessary.

Skilled Nursing Facility Care: Semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day hospital stay).

Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services.

Hospice Care: Medical and support services from a Medicare-approved hospice for people with a terminal illness, drugs for symptom control and pain relief, and other services not otherwise covered by Medicare. Hospice care is given in your home. However, short-term hospital and inpatient respite care (care given to a hospice patient by another caregiver so that the usual caregiver can rest) are covered when needed.

Blood: In most cases, the hospital gets blood from a blood bank at no charge, and you won't have to pay for it or replace it. If the hospital has to buy blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated.

Medicare Part B

Medicare Part B (Medical Insurance) helps cover your doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. You pay the Medicare Part B premium.

Medicare Part B Helps Cover:

Medical and Other Services: Doctors' services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also helps cover second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speech-language therapy.

Clinical Laboratory Services: Blood tests, urinalysis, and more.

Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services.

Outpatient Hospital Services: Hospital services and supplies received as an outpatient as part of a doctor's care.

Blood: If the provider gets blood from a blood bank at no charge, you won’t have to pay for it or replace it. However, you’ll pay a copayment for the blood processing and handling services for every unit of blood you get, and the Part B deductible applies. If the provider has to buy blood for you, you must either pay the provider costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.

Medicare Also Helps Cover:

  • Ambulance services (when other transportation would endanger your health).
  • Artificial eyes.
  • Artificial limbs that are prosthetic devices, and their replacement parts.
  • Braces - arm, leg, back, and neck.
  • Chiropractic services (limited), for manipulation of the spine to correct a subluxation.
  • Emergency care.
  • Eyeglasses - one pair of standard frames after cataract surgery with an intraocular lens.
  • Immunosuppressive drug therapy if a transplant was paid for by Medicare.
  • Kidney dialysis.
  • Macular degeneration of the eye.
  • Medical nutrition therapy services for people with diabetes or kidney disease with a doctor's referral.
  • Medical supplies - items such as colostomy bags, surgical dressings, splints, casts, and some diabetic supplies.
  • Outpatient prescription drugs (very limited). For example, some oral drugs for cancer.
  • Preventive services.
  • Prosthetic devices, including breast prosthesis after mastectomy.
  • Second opinion by a doctor (in some cases).
  • Services of practitioners such as clinical social workers, physician assistants, and nurse practitioners.
  • Telemedicine services in some rural areas.
  • Therapeutic shoes for people with diabetes (in some cases).
  • Transplants - heart, lung, kidney, pancreas, intestine, bone marrow, cornea, and liver (under certain conditions and when performed at approved facilities).
  • X-rays, MRIs, CAT scans, EKGs, and some other diagnostic tests.

What healthcare costs are NOT paid for by Medicare Part A and Part B?

Original Medicare does not cover everything, and some of the health care costs not covered by Medicare include:

  • Acupuncture.
  • Dental care and dentures (in most cases).
  • Cosmetic surgery.
  • Custodial care either at home or in a nursing home.
  • Health care you get while traveling outside of the United States (except in limited cases).
  • Hearing aids and hearing exams.
  • Orthopedic shoes.
  • Outpatient prescription drugs (with only a few exceptions).
  • Routine foot care (with only a few exceptions).
  • Routine eye care and most eyeglasses.
  • Routine or yearly physical exams.
  • Certain screening tests.
  • Certain shots (vaccinations)

Medicare Advantage plans may include extra benefits such as prescription drugs, dental care, routine physical and vision services. Contact us to find out which Medicare Advantage plans are available in your area.