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What does Medicare Cover?

Medicare provides healthcare coverage for people age 65 and older, as well as people under 65 who have certain disabilities or permanent kidney failure that requires dialysis or a transplant.

facts about medigap insurance plans

How heavily are the plans regulated?

Medicare is divided into four parts. Part A helps to cover inpatient hospital care. That includes critical access hospitals, home health care, hospice care, inpatient care at religious non-medical health care institutions, inpatient care at skilled nursing facilities (not custodial or long-term care), inpatient rehabilitation facilities, and long-term care hospitals. If you or your spouse has paid Medicare taxes through employment, Part A will probably be free for you.

If it is not free, you may be able to buy Part A coverage if you are at least 65, enrolling in or entitled to Part B, and you meet citizenship or residency requirements. You may also be able to buy Part A coverage when you’re under 65, disabled, and your free Part A coverage ended when you returned to work.

Part B helps to cover medically necessary outpatient services. That includes doctor services, home health services, lab tests, outpatient care, services at hospitals where you are not checked in, and services from other medical non-hospital providers. Medigap does work a little bit differently.

Part B requires everyone pay a monthly premium, and it has an annual deductible that must be met before charges are covered. If you don’t sign up for Part B when first eligible, you may have a penalty for late enrollment.

Medicare Part C is provided by private companies that Medicare approves to take care of your Part A and B coverage, and you have to pay a premium. These Medicare Advantage Plans or MA Plans must cover the services that original Medicare covers except hospice care. The original Medicare covers hospice care even when you are enrolled in a Medicare Advantage Plan.

Medicare Advantage Plans can give you extra coverage, such as dental, hearing, vision or other services. Within the rules that Medicare sets for these plans, Advantage plans can have varying out-of-pocket costs and requirements. For example, you may be limited in your choice of doctors, or you may need to be referred to see a specialist. Part D provides prescription drug coverage through plans that vary in cost, and which do not all cover the same prescription drugs.

NEXT: What is Medicare Supplemental Insurance?

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