Your search for affordable Health, Medicare and Life insurance starts here.

Call us 24/7 at (800) 439-6916 or Find an Agent near you.

Before you sign up for Medicare, it’s important to know what Medicare covers. You have a lot of options, so it’s best to do some research first. That way, you can choose the best type of Medicare plan for the healthcare services you need. 

If you want to skip the lengthy research, use our Medicare tool. Answer a few quick questions, and we’ll suggest a plan that may work best for your lifestyle. But if you want an answer to “What does Medicare cover?” first, we’ll explain the basics below.

What Is Covered by Medicare Part A and B?

Medicare Parts A and B, also called Original Medicare, cover the following:

Medicare Part A (hospital insurance):

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility*
  • Hospice care
  • Home health care

*Does not include custodial or long-term care

Medicare Part B (outpatient services):

  1. Preventive services (vaccines, lab tests, etc.)
  2. Diagnostic services
  3. Ambulance services
  4. Durable medical equipment

Keep in mind that what Medicare covers does not include 100% of the costs. You are responsible for monthly premiums, and you’ll likely have to pay a deductible, copays, and/or coinsurance. If you have to see a healthcare provider often or have a long hospital stay, your out-ot-pocket costs can add up! To offset some or most of these charges, you can purchase a Medicare Supplement plan.

What Is Not Covered by Medicare?

Original Medicare does not cover most prescription medications that you would take outside of a medical facility. To get comprehensive drug coverage for medications you pick up at the pharmacy, you can purchase a Medicare Part D drug plan from a private insurer. Additionally, most Medicare Advantage plans include prescription drug coverage. Some other services not covered by Medicare include:

  • Long-term care
  • Most dental care
  • Routine eye exams
  • Dentures
  • Cosmetic surgery  
  • Acupuncture  
  • Hearing aids and hearing screenings
  • Routine foot care

What Do Medicare Supplement Plans Cover? 

Medicare Supplement plans (also known as Medigap plans) are offered by private insurance companies to help with medical expenses that Original Medicare doesn’t cover. Some of these costs include:

  1. Deductibles, coinsurance, & copays
  2. Hospital costs after Medicare Part A benefits are used
  3. Blood transfusions
  4. Part B excess charges
  5. Foreign travel emergencies

There are a number of Medicare Supplement plans to choose from with varying levels of coverage, regional availability, and costs.

What Does Medicare Part D Cover? 

Medicare Part D covers prescription medication for those enrolled in Original Medicare or those enrolled in Medicare Advantage plans that don’t include drug coverage. These plans are sold by private insurance companies with a variety of coverage levels and costs. 

What Does Medicare Advantage Cover?

A Medicare Advantage plan (also known as Medicare Part C) is sometimes considered an all-in-one alternative to Original Medicare provided by private insurance companies. It includes the same Part A and Part B coverage as Original Medicare, and most plans include additional coverage for prescription drugs, dental, vision, and hearing.

Medicare Advantage plans come with a variety of copays, coinsurance, and premiums (including $0 per month*). The plans come with yearly limits on out-of-pocket costs, so they can be a lower-cost choice for some individuals.

Have Questions About What Medicare Covers? We’re Here to Help!

Understanding Medicare coverage can be a challenge. That’s why HealthMarkets is available anytime to help you navigate your choices at no cost to you**. Our FitScore® helps make shopping for Medicare easy.

To compare individual Medicare plans, visit us online. You can quickly find which plans include your providers and medications, get up-to-date pricing, and even apply online.


46757-HM-1120

Medicare has neither reviewed nor endorsed this information.
*You must still pay your Part B premium when selecting a Medicare Advantage plan with a $0 premium.
**Agents may be compensated on enrollment. No obligation to enroll. 

References:
https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices | https://www.medicare.gov/what-medicare-covers/whats-not-covered-by-part-a-part-b | https://www.medicare.gov/what-medicare-covers/what-part-a-covers | https://www.medicare.gov/what-medicare-covers/what-part-b-covers https://www.medicare.gov/drug-coverage-part-d/what-medicare-part-d-drug-plans-cover | https://www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover/medicare-advantage-plans-cover-all-medicare-services | https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work | https://www.medicare.gov/supplements-other-insurance/how-to-compare-medigap-policies | https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work#:~:text=Most%20Medicare%20Advantage%20Plans%20include,Fee%2Dfor%2DService%20plans | https://www.medicare.gov/coverage/prescription-drugs-outpatient | https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance | https://www.healthmarkets.com/resources/medicare/difference-between-medicare-a-and-b/

Related Information