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Medicare Insurance Comparison

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What does Medicare not cover?

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Just the Essentials…

  • Medicare is actually made up of several different parts, each of which are responsible for covering specific types of healthcare treatments and services.

  • Original Medicare Parts A and B typically covers hospital stays, doctor’s appointments, emergency surgery, etc.

  • Medicare Part C (also known as Medicare Advantage) is health insurance coverage that is sold separately by private companies. Usually, Medicare Advantage can cover things that Original Medicare cannot, like dental, vision, and hearing needs.

  • Medicare Part D is designed to help you pay for your prescription medications. What is and is not covered by Part D depends on your plan’s formulary. Medicare Part D can be bundled as part of your Medicare Advantage plan, or sold separately.

  • The best way to find Medicare coverage that works for you, your healthcare needs, and your lifestyle is to research and compare available plans. The licensed insurance agents at MedicareInsurance.com can help.

How does Medicare health insurance work?

Medicare is a national health insurance program that is regulated and managed by the United States federal government. It is specifically designed to assist seniors and certain disabled individuals in paying for their healthcare costs in the absence of employer-sponsored coverage.

One first becomes eligible for Medicare as they approach the age of 65, usually beginning in the three months prior to their 65th birthday. As stated, certain individuals may also become eligible for Medicare upon the diagnosis of certain qualifying diseases or disabilities.

Medicare health insurance is made up of four major parts: Original Medicare (Parts A and B), Medicare Part C (Medicare Advantage), and Medicare Part D (prescription drug coverage. Each of these parts of Medicare are responsible for providing insurance coverage for differing healthcare needs.

What does each part of Original Medicare cover?

Original Medicare Part A

Medicare Part A is the hospital insurance coverage portion of Medicare. Generally, Part A covers inpatient hospital care, temporary skilled nursing facility care, temporary nursing home care that is non-custodial, hospice care, medically necessary home health care.

For most Medicare beneficiaries who have paid Medicare taxes for 40 quarters or more, Part A is available with no premium charge. However, if you or your spouse paid Medicare taxes for less than 30 quarters, you must pay a standard Part A premium. If you or your spouse paid Medicare taxes for 30-39 quarters, you must pay a discounted premium.

Medicare Part A always carries a deductible for each benefit period, as well as coinsurance after a specific amount of time has passed over the course of your care.

Original Medicare Part B

Medicare Part B is the traditional medical insurance coverage portion of Medicare. Part B primarily covers two types of healthcare services: medically necessary treatments and supplies, like doctor’s appointments and durable medical equipment; and preventative healthcare services, like screenings and vaccines.

In addition, Medicare Part B covers clinical research, ambulance service, inpatient and outpatient mental health service, and limited outpatient prescription medications.

You must pay a monthly premium in order to access Medicare Part B coverage, though the amount of this premium may vary depending on your income level. If you receive benefits from Social Security, the Railroad Retirement Board, or the Office of Personnel Management, this premium will be automatically deducted from your benefit payment. If you do not receive benefit payments, you will receive a bill.

Medicare Part B also carries a deductible and a coinsurance. However, if you receive the aforementioned medical services from a healthcare provider who accepts assignment, you will likely pay nothing for them at the time of service.

What Original Medicare does not cover.

Original Medicare covers a large portion of the healthcare costs you will encounter after the age of 65, but Original Medicare may also leave specific gaps in your health insurance coverage.

Original Medicare is designed to assist seniors and the disabled in paying for the majority of their necessary healthcare costs, but there are actually several treatments that Original Medicare does not cover. Services not covered by Medicare Parts A and B include:

  • Most prescription drug costs
  • Long-term care in a nursing home, retirement community, or assisted living facility
  • Deductibles and copays for health insurance coverage
  • Most dental care
  • Routine vision care
  • Most hearing care
  • Overseas medical care

How can I find Medicare coverage that works specifically for me?

While Original Medicare Parts A and B can and does offer necessary health insurance coverage to millions of seniors and disabled Americans, Original Medicare doesn’t pay for every aspect of healthcare that you may encounter as you live through your golden years. 

Luckily, there are options that will allow you to access more comprehensive Medicare coverage for services and treatments you need in accordance with your general health and lifestyle.

Medicare Part C (Medicare Advantage)

Medicare Part C, also known as Medicare Advantage, usually takes the form of a privately-sold health insurance plan. These plans are sold by private insurance companies, and as a result, their availability, exact benefits, and costs will vary.

That being said, most Medicare Advantage plans provide coverage for additional healthcare needs beyond what is covered by Original Medicare. Mostly, this includes things like eyeglasses and contacts, dentures and dental implants, and hearing aids. In some cases, Medicare Advantage may also cover transportation to and from appointments.

Medicare Part D: Prescription Drug Coverage

Medicare Part D is responsible for the coverage of various prescription medications. Part D may cover both name-brand and generic medications, but the exact medications that are covered will depend on your plan’s formulary, which is a pre-approved list of covered prescription drugs.

Medicare Part D can often be bundled into a Medicare Advantage plan, which will usually save you money on its monthly premiums. If desired, however, Medicare Part D can also be purchased in the form of standalone plans.

Medicare Part D: Prescription Drug Coverage carries a yearly deductible, copayments and/or coinsurance, and coverage gap costs. The exact amount you will pay for Part D depends on both your income level and the plan in which you are enrolled. 

At MedicareInsurance.com, our licensed insurance agents are committed to helping your research and compare Medicare health insurance options that work for you. In addition to helping you find great plans for great prices, we can also help you determine your eligibility and even submit forms that may entitle you to cost-saving programs. To get started, contact us today!

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