Understanding the Coverage Provided By Medicare

Medicare is a federal health insurance program in the United States that primarily covers citizens 65 years of age or older. It covers certain medical services, and some of them come with a cost that will be paid by the insured. Although this gives members additional options for coverage and pricing, it also adds a layer of complexity for those looking to enroll.

If you plan to acquire Medicare, you must first understand its coverage before you decide which coverage to take and begin the application process. That said, below are the different Medicare coverage to help you familiarize yourself with the options and decide which is ideal.

Part A (Hospital Insurance)

The first coverage Medicare provides to its policyholders is the Hospital Insurance, also called Part A coverage. Generally speaking, this element of Original Medicare assists in paying for inpatient treatments, including hospital stays and care at skilled nursing facilities.

Many services you obtain in a hospital or long-term care facility are typically covered in Medicare Part A. 

An example of an instance when Medicare Part A covers inpatient care is when you are formally admitted to the hospital by a physician, Part A will cover you for up to ninety days throughout your benefit period. This time frame starts on the day of your admission and concludes after you have spent 60 consecutive days outside the hospital.

Part A will cover your hospital stays from days 1 through 60 after you’ve met your deductible. You will pay a daily coinsurance for days 61 through 90. You may spend up to 60 lifetime reserve days if your hospital stay exceeds ninety days. 

Medicare provides additional days of coverage for extended hospital stays. On the other hand, lifetime reserve days are not renewed and have a daily coinsurance need.

If you still don’t have Medicare, you should consider getting one in case you need financial assistance from the hospital. Start researching the requirements and documents for Medicare application so that you can apply for a policy. 

Part B (Medical Insurance)

The next coverage of Medicare is medical insurance, also known as Part B. Part B aids in covering the cost of approved medical services and supplies when your healthcare provider thinks it’s necessary. 

To assist in preventing, identifying, or treating a medical condition, Part B also includes some preventative treatments such as examinations, lab tests, and screening immunizations. OPD patients are the ones who commonly use this coverage.

Furthermore, you can also use your Medicare Part B for emergency ambulance transportation and mental health screenings. However, Medicare Part B doesn’t cover the majority of prescription drugs and only has a very limited offering for drug coverage. 

Part C (Medicare Advantage)

Medicare Part C, or Medicare Advantage plans, is a comprehensive program offering extra coverage on top of the same benefits you can get from Medicare Parts A and B. If you require more than what Original Medicare offers, this coverage would be the one you will need.

Aside from covering Part A and Part B benefits plus extras, Part C also covers Part D or the Prescription Drug Coverage. Most policyholders preferred the Medicare Advantage plan over the other options. 

So, if you’re looking for coverage that can provide you with overall benefits, Medicare Advantage would be the one you should consider

Part D (Drug Coverage)

This next Medicare coverage is the Prescription Drug Coverage or Part D. This plan covers your prescription medications. However, remember that each Medicare prescription drug plan has a formulary or list of covered authorized medications. 

Each of the frequently prescribed medication categories must include at least two medications in the formulary, along with the following:

  • Antipsychotic drugs
  • Antidepressants
  • Immunosuppressant drugs
  • Cancer medication
  • Aids/HIV drugs

Part D does not cover all prescription medications. Examples of these are medications used to treat erectile dysfunction and over-the-counter medications. When evaluating prescription drug plans, it’s critical to consider their individual restrictions.

Medicare Supplement Insurance (Medigap)

Last but not least is the Medicare Supplement Insurance or Medigap coverage. Medigap is an additional insurance that you can purchase from a private provider to help cover your portion of Original Medicare costs. 

In most states, letters such as Plan G or Plan K identify standard policies. The benefits of every lettered plan are the same regardless of the insurance provider.

Private insurance firms presently provide ten distinct Medigap plans for purchase. Medigap plans may cover the following out-of-pocket expenses related to your Medicare services:

  • Excess charges
  • Deductibles
  • Hospital cost and coinsurance
  • Copayment cost and hospice coinsurance
  • The first three pints of blood transfusion
  • Medical costs when you travel outside the U.S.A
  • Deductible and monthly premium
  • Coinsurance costs for skilled nursing facilities
  • Copayment and coinsurance costs

It’s critical to understand that Medigap policies do not expand Medicare coverage. Rather, they solely assist with the expenses related to the Medicare programs you are signed up for.

How To Be Eligible For Medicare

You will become eligible and can start signing up for original Medicare three months before turning 65. Several circumstances allow you to apply for Medicare at any age, such as having a disability and having received an SSDI or Social Security Disability Insurance and if you have been diagnosed with ESRD or End-Stage Renal Disease.

Author Profile

The Editorial Team at Lake Oconee Health is made up of skilled health and wellness writers and experts, led by Daniel Casciato who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We aim to provide our readers with valuable insights and guidance to help them lead healthier and happier lives.