Coverage With Medicare

Navigating Medicare coverage can feel overwhelming, especially when trying to understand what services are included and what’s not. Knowing the ins and outs of Medicare coverage can help you make informed decisions about your healthcare and avoid unexpected costs. Here’s a breakdown of what Medicare typically covers—and what it doesn’t.

What’s Covered by Medicare

Medicare Part A (Hospital Insurance):

  • Inpatient hospital stays

  • Skilled nursing facility care (following a qualifying hospital stay)

  • Hospice care

  • Home health care (limited services)

Medicare Part B (Medical Insurance):

  • Doctor’s visits

  • Preventive services (like flu shots and screenings)

  • Outpatient care

  • Durable medical equipment (like wheelchairs or oxygen equipment)

  • Mental health services

  • Certain lab tests and diagnostic screenings

Medicare Part D (Prescription Drug Coverage):

  • Prescription medications (varies by plan)

  • Vaccinations not covered by Part B (like the shingles vaccine)

Medicare Advantage (Part C):

  • Combines Part A, Part B, and usually Part D

  • May offer additional benefits like vision, dental, and hearing coverage

  • Wellness programs

What’s Not Covered by Medicare

While Medicare covers many essential services, there are several common healthcare needs that are not included under Original Medicare (Part A and Part B):

  • Routine dental care (cleanings, fillings, dentures)

  • Vision exams and eyeglasses

  • Hearing aids and exams for fitting them

  • Long-term care (like nursing home care for daily activities)

  • Cosmetic procedures

  • Acupuncture (except for chronic lower back pain)

  • Prescription drugs (without a separate Part D plan)

How to Fill the Gaps

To cover services that Medicare doesn’t, you can explore options like:

  • Medicare Advantage Plans (Part C): These often provide dental, vision, and hearing benefits.

  • Medigap (Supplemental Insurance): Helps cover out-of-pocket costs like deductibles and coinsurance.

  • Medicare Savings Programs: Offers financial assistance for those who qualify.

  • Prescription Drug Plans (Part D): To ensure medication coverage.

Understanding what Medicare covers—and what it doesn’t—can help you plan ahead and avoid unexpected expenses. If you need help navigating your options or finding additional coverage, reach out to a trusted Medicare advisor. Your health matters, and having the right coverage in place can give you peace of mind.

Have questions about your Medicare coverage? Contact us today to learn more!

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Other Medicare Questions? We can be reached at 814.201.9708 or at jocelyn@evolveinsurancegrp.com.

Jocelyn Wolf