What Does Medicare Cover for Seniors?

Work habits, career paths, and times, in general, have changed through the years, but 65 is still considered the milestone age when many Americans retire. This is in large part due to the Social Security Act of 1935, which set the minimum age for receiving full retirement benefits at 65 years old. If you or your loved one are nearing retirement age, there is no doubt that learning about what Medicare covers will be of interest. With your income transitioning to a fixed state, Medicare can greatly assist with the cost of health care.

With more than 54 million seniors enrolled in Medicare (and another 8 million enrollees under 65), the federal government’s program is enormous in scope and can be complex. We see so many stories about Medicare in the news, we hear about the different types of Medicare categories, and it’s clear that the information overload can be daunting to sift through. This is where Referah comes in. For just a few minutes of your time, we’re going to break down the four main categories of Medicare as well as supplemental programs and give you a basic understanding of the various plans and how to get the most from each.

The Different Types of Medicare Coverage

Let’s take a look at the main Medicare categories and the coverage provided under each umbrella.

What Does Medicare Part A Cover?

Medicare Part A provides basic hospitalization coverage. This includes the costs incurred when you are an inpatient formally admitted to a hospital under doctor’s orders. A few examples:

• Walkers and wheelchairs
• Hospice Care
• Blood transfusions
• Some Home Care and Home Health Care services

What is Not Covered Under Medicare Part A?

Medicare Part A, sometimes referred to simply as “hospital insurance,” will cover inpatient care in hospitals and some Skilled Nursing Facilities (SNFs) but does not provide coverage for custodial or long-term care in most cases.

What Does Medicare Part B Cover?

Medicare Part B covers outpatient care, including doctor’s visits, preventative health care, and diagnostic tests. Many seniors combine Parts A and B to get the most comprehensive coverage, (e.g., if you’re staying in a hospital, that actual time logged staying in a room would be covered by Medicare Part A, while the doctor’s services would be at least partially covered under Part B.)

Medicare Part B covers a myriad of services and tests, including but not limited to:

• Ambulance and first responder services
• Screening for cancer and diabetes
• Vaccinations
• Diabetes supplies
• Durable Medical Equipment (DME)
• Mental health services
• Clinical research

What is Not Covered Under Medicare Part B?

Medicare combines non-coverage items in Part B and Part A, so services like dental care, eye exams, foot care, hearing aid fittings, and long-term care (also known as custodial care) would not be covered.

What Does Medicare Part C Cover?

Medicare Part C, also known as “Medicare Advantage,” is a private insurance option that bundles Medicare Part A, Medicare Part B and additional coverage not included in those two plans. In order to purchase a Medicare Part C plan, you must be enrolled in Medicare.

Some of the extra benefits provided under Medicare Part C include:

• Prescription drugs plans
• Dental plans
• Hearing and vision aids

What is Not Covered Under Medicare Part C?

The advantages of Medicare Part C include “one stop shopping,” e.g., everything from dental care to prescription drugs to vision care and many other crucial benefits.

There are many potential savings, but these plans often have out-of-pocket limits on costs and long-term care services such as meal delivery and specialized Home Health Care. Additionally, there are certain limitations depending on the plan, and not all of the above benefits may be paid in full depending on your coverage. Beneficiaries have also used Medicare Part C to assist with inpatient care, however, benefits like the use of a private room may only be covered if a medical professional classifies it as a necessity for safety.

Other Types of Medicare Coverage

Medicare Part D covers prescription drugs that aren’t covered by Part B. The majority of those enrolled in Part D pay a premium for this coverage. (Plans vary, depending on which prescription drugs are needed, whether you’re using a brand name or a generic drug, etc.) You may also have to make co-payments or pay a deductible.

Medigap, often referred to as Medicare Supplement Coverage, is another type of coverage that is available. It is designed to fill the gaps that Medicare Parts A and B don’t cover. Medigap plans are sold by private insurance companies.

The use of Medicare coverage can often impact your financial plans. To learn more about protecting your finances, you can read our article “What is a Fiduciary and Why Do I Need One?”

Find Senior Care Near You

Medicare covers many healthcare services, from hospitalization to outpatient services—but there are medical services that are not covered by Medicare. While Medicare does not generally cover the cost of care and support in a Senior Living Community, there are many reasons why this type of living arrangement may be more beneficial and financially sound, especially when Assisted Living and Memory Care services are required.

Learn more about senior living communities near you and talk with our team of professionals for any questions about Medicare, and choosing the right path for the best future.