Medicare Coverage

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Medicare Coverage by Topic

Original Medicare is government-sponsored health insurance that includes Part A (hospital insurance) and Part B (medical insurance). It can be confusing to figure out which services Medicare covers, and which it doesn't. Read more below to learn about the Medicare benefits you may be entitled to under Original Medicare.

Original Medicare -- Part A

In general, Medicare Part A benefits include care you get as a hospital inpatient. For example:

  • Skilled nursing services
  • A semi-private room
  • Meals
  • Medications given to you as part of your inpatient treatment
  • Hospital services and supplies

Medicare hospital coverage: If you're enrolled in Medicare and you're in the hospital, it's important to know whether you're considered an inpatient or an outpatient. This can affect how much you pay for your care. If your Medicare doctor has admitted you to a hospital as an inpatient, Medicare Part A coverage applies. It's possible to stay overnight at a hospital and still be an outpatient, in some cases (for example, if you're undergoing observation). If you haven't been admitted as an inpatient, Medicare Part B coverage usually applies.

Original Medicare -- Part B

Medicare Part B covers many types of doctor visits and medical services. Please note that Medicare coverage applies only if certain conditions are met (for example, a service may have to be medically necessary and delivered in a Medicare-enrolled facility). Costs such as copayments and deductibles may apply. This is not a complete list.

  • Preventive services, such as annual checkups (wellness) and vaccinations
  • Durable medical equipment (DME)
  • Mental health services
  • Ambulance services
  • Diabetic supplies
  • Second opinion prior to surgery

Some services may be covered under Medicare Part A, Part B, or partially by both, depending on the situation. For example, cataract surgery may be outpatient surgery (covered by Part B) or inpatient surgery (covered by Part A).

About Medicare prescription drug coverage: Original Medicare (Part A and Part B) typically doesn't cover medications you take at home. Part A covers drugs you get as part of hospital inpatient care, and Part B covers certain drugs you may get as an outpatient - these are usually drugs that need to be administered to you at your doctor’s office. For most prescription drug coverage, you need to sign up for Medicare Part D. This optional coverage is available from private, Medicare-approved insurance companies.

What about Medicare coverage when you're not yet 65, but you have a disability?

If you're eligible for Social Security or Railroad Retirement Board disability benefits, you might qualify for Medicare. Learn more about Medicare and disability, including when your Medicare benefits may start.

Medicare Advantage (Medicare Part C)

There are some things Original Medicare doesn't cover, such as routine dental or vision services, or prescription drugs in most situations. Many Medicare Advantage (Medicare Part C) plans do offer such benefits. Medicare Advantage plans are offered by private insurance companies approved by Medicare, and must include at least as much coverage as Medicare Part A and Part B (except hospice services, which Medicare Part A covers even if you have a Medicare Advantage plan). Costs and availability of Medicare Part C plans vary, but you continue paying your Medicare Part B premium when you're enrolled in a Medicare Advantage plan.

Tips from our licensed insurance agents
When signing up for Medicare, ask about dental and vision care
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