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Medicare Covered Services and How to Maximize Your Benefits

Navigating the Medicare can be overwhelming, but understanding what services are Medicare services covered is crucial to making the most of your Medicare benefits details. In this comprehensive guide, we break down everything you need to know about services included in Medicare and how to ensure you’re getting the care you deserve. From preventive screenings to hospital stays, we’ve got you covered. Let’s dive in and demystify Medicare covered services together!

Introduction to Medicare Covered Services

Medicare is a insurance program that provides coverage for certain healthcare services and supplies for individuals who are 65 years or older, as well as people with disabilities & those with end-stage renal disease. The program of four parts – A, B, C, and D – each providing coverage for specific services.

In this section, we will provide you with an overview of the different types of Medicare-covered services and what they entail.

Part A:

Also known as hospital, Part A covers inpatient care in hospitals, skilled nursing facilities, hospice, and home health care. This includes necessary hospital stays due to illness or injury, skilled nursing facility stays for rehabilitation after a hospital stay, hospice care for those with terminal illnesses & limited home health services.

Part B:

Part B covers medically services like doctor visits, preventive care screenings (e.g., mammograms), outpatient surgeries and procedures, lab tests, and X-rays. It also includes some durable medical equipment like wheelchairs or walkers.

Part C:

Medicare Part C is also known as Advantage. It is offered by companies approved by Medicare. These offer all the benefits of Parts A and B plus additional coverage such as dental care or prescription drugs.

Part D:

Medicare Part D provides coverage for drugs through private insurance companies contracted by Medicare. This helps reduce out-of-pocket costs for prescription medications, which can be expensive without insurance coverage.

Now that we have briefly gone over the different Medicare parts let’s take a closer look at what exactly is covered under these plans.

Covered Services:

Under Parts A & B, Original Medicare Plans cover a range of services, including but not limited to:

  • Doctor visits: This can include primary care physicians as well as specialists.
  • Preventive Care: Screenings such as flu shots and mammograms fall under this category.
  • Emergency Services: This includes ambulance services, emergency room visits, and urgent care.
  • Hospital Stays: Necessary hospital stays for illnesses or injuries are covered under Part A.
  • Home Health Care: Limited in-home care is covered under Part A.
  • Medical Supplies: Durable medical equipment like wheelchairs or walkers fall under this category.

It’s important to note that Medicare may not cover all these services at 100%, and there may be deductibles, copayments, or coinsurance required. Additionally, specific criteria must be met for certain services to be covered.

What is Medicare?

Medicare is a insurance program in the United that provides coverage who are 65 years or older, people with disabilities. It was signed into law in 1965 as an amendment to the Social Security Act and is administered by the Medicare & Medicaid Services (CMS).

There are four parts to Medicare: Part A, B, C, & Part D. Each Part covers different services & has its own costs.

Part A is also known as Hospital. It covers inpatient hospital care, skilled nursing facilities, hospice care, and some home health care. Most people do not have to pay for Part A because they or their spouse paid taxes while working.

Part B is Medical Insurance, which covers medically necessary services like doctor’s visits, preventive services such as screenings & vaccinations, durable medical equipment (e.g., wheelchairs), laboratory tests, outpatient mental health treatment, ambulance services, and more. There is a monthly premium for Part B based on income.

Part C is also called Medicare Advantage Plans. These are offered by companies approved by Medicare to provide all-in-one healthcare benefits, including Parts A & B coverage, along with national benefits such as vision, dental care, or prescription drug coverage. They may also offer lower out-of-pocket costs compared to Original Medicare but can limit which healthcare providers you can see.

Part D provides drug coverage through private insurance companies approved by Medicare. It helps cover the cost of drugs needed for treatment or prevention of specific conditions. You can get drug coverage through a stand-alone plan if you have Medicare or through an Advantage Plan that includes prescription drug coverage.

It’s important to note that not all healthcare services are covered by Original Medicare. There are certain limitations & exclusions in coverage such as cosmetic surgery, most dental care, routine vision or hearing exams, and long-term care. However, there may be other options available for these services through private insurance plans or Medicaid.

Medicare is a comprehensive insurance program that provides essential coverage for seniors & individuals with disabilities in the United States. Understanding the different parts of Medicare & their respective coverage will help you make decisions about your healthcare needs and costs.

Types of Medicare Coverage

There are several different types of Medicare coverage available to help seniors and people with disabilities afford necessary medical care. Each type of Medicare coverage offers different benefits and has specific eligibility requirements. In this section, we will discuss the four main types of Medicare coverage: Part A, Part B, Part C, and Part D.

Part A: Hospital Insurance

Medicare Part A covers inpatient hospital stays, nursing facility care, hospice care, & limited home health services. Most people do not have to pay for Part A because they or their spouse paid taxes while working. However, there may be deductible and coinsurance costs associated with using these services.

Part B: Medical Insurance

Medicare Part B covers medical such as doctor visits, preventive care, ambulance services, durable medical equipment (DME), mental health care, & outpatient therapy. Unlike Part A, Part B has a monthly premium based on income level. Additionally, beneficiaries must meet an annual deductible before Medicare begins covering 80% of the cost of these services.

Part C: Medicare Advantage Plans

Also known as Medicare Advantage plans or MA plans, Part C combines Parts A and B along with benefits such as drug coverage (Part D), vision care, dental care, or wellness programs into one plan offered by companies approved by Medicare. These plans often require copayments or deductibles for covered services but offer additional flexibility in choosing healthcare providers.

Part D: Prescription Drug Coverage

Medicare prescription drug coverage is available through stand-alone prescription drug plans (PDPs) or through a Medicare Advantage plan that includes drug coverage (MA-PDs). These plans provide varying levels of drug coverage at different prices depending on the specific medications needed.

It is important to note that while some types of Medicare coverage may overlap in certain areas (such as prescription drugs being covered under both Parts C and D), individuals cannot enroll in more than one type of Medicare coverage at a time. It is important to carefully review your needs & options before choosing which type of Medicare coverage is best for you.

Understanding Medicare Part A, B, C, & D

Understanding Medicare Part A, B, C, & D can be confusing for many people. These are the four different parts of Medicare that provide coverage for various healthcare services. Each Part has its own set of rules and benefits, so it is important to understand what they cover and how they work together.

Medicare Part A is commonly known as the hospital. It covers inpatient care in hospitals, hospices, nursing facility care, & some home health care services. Most people do not have to pay for Part A because they or their spouse paid taxes while working. However, there may be deductibles and copayments associated with this Part.

On the other hand, Medicare Part B is medical insurance that covers medically necessary services such as doctor visits, preventive care, lab tests, durable medical equipment (DME), and outpatient procedures. Unlike Part A, most people have to pay a monthly premium for Part B based on their income level. There are also annual deductibles and coinsurance associated with this Part.

Medicare Advantage Plans (Part C) are offered by companies that have been approved by Medicare. These combine Parts A and B coverage along with additional benefits like drug coverage (Part D). They may also offer benefits such as vision or dental coverage but may require you to use specific providers within their network.

Medicare Part D provides drug coverage through private insurance companies approved by Medicare. It helps cover the cost of drugs at participating pharmacies or through mail-order services. Similar to Part B premiums, the cost of Part D depends on your income level.

It is important to note that enrolling in Parts A and/or B is automatic if you are receiving Social benefits when you turn 65 years old. If not automatically enrolled in these parts at age 65 due to not receiving Social Security or Railroad Retirement Board benefits yet, then enrollment must be done during the initial enrollment period (IEP). The IEP is a 7-month window: three months before you turn 65 years old, the month of your birthday, &  three months after. If you do not enroll during this time, you may have to pay a late enrollment penalty.

Understanding Medicare Parts A, B, C, & D can be overwhelming at first, but it is important to know what each Part covers in order to make decisions about your healthcare needs. It is also essential to remember that each Part has its own set of rules & benefits, so it is crucial to review the details and determine which parts are best for your individual situation.

medicare covered services
services included in Medicare
Medicare benefits details
Medicare services covered

What services are covered by Medicare?

Medicare is an insurance program that mainly caters to individuals who are 65 years old or above, as well as those with certain disabilities. It is comprised of four parts – Part A, Part B, Part C (Advantage plans), and Part D (drug coverage). One of the most important aspects of Medicare is understanding what services are covered under each Part. In this section, we will dive into the details of what services are covered by Medicare.

Part A covers inpatient hospital, skilled nursing facility care, hospice care, and home health care. Inpatient hospital care includes semi-private room accommodation, meals, general nursing care, medications administered during your stay, and other necessary hospital services and supplies. Skilled nursing facility care refers to a short-term stay in a nursing home for purposes after an illness or injury. Hospice care provides comfort & support for individuals with an illness who have less than six months to live. Home health care covers skilled nursing services and therapy at home for individuals who are unable to leave their homes due to medical.

Part B covers medical services such as doctor’s visits, preventive services like yearly wellness exams & screenings, diagnostic tests and lab work, outpatient surgeries including anesthesia & surgeon fees, ambulance transportation if deemed necessary by a doctor, mental health services such as counseling sessions with licensed professionals, durable medical equipment like wheelchairs or walkers if prescribed by a doctor, & certain prescription drugs administered in an outpatient setting.

Part C refers to Medicare Advantage plans offered by companies that are approved by Medicare. These provide all the benefits covered under Parts A and B, along with benefits like vision, dental, or hearing coverage, depending on the plan you choose.

Lastly, Part D covers prescription drug costs incurred at pharmacies within the network approved by your chosen plan. It also offers financial assistance for individuals with limited income and resources.

It is important to note that Medicare does not cover all medical services. Some of the services that are not covered include long-term care, dental care, eye exams for glasses, cosmetic surgeries, and acupuncture. However, there may be exceptions in certain situations, so it is always best to check with your healthcare provider or the Medicare website for specific coverage information.

Understanding what services are covered by Medicare can help you make decisions about your healthcare needs. It is essential to familiarize yourself with the benefits available under each Part of Medicare and any limitations or exclusions to avoid unexpected expenses.

How to use the NewMedicare website to find covered services

Navigating the world of Medicare coverage can be overwhelming, but thankfully, the NewMedicare website has been designed to make it easier for beneficiaries to find information about their covered services. In this section, we will provide a step-by-step guide on how to use the website effectively.

Step 1: Access the Website

The first step is to access the NewMedicare website by typing www.medicare.gov into your internet browser. Once you are on the homepage, you will see a search bar and several tabs at the top of the page.

Step 2: Understand Your Coverage Options

Before searching for specific covered services, it is important to understand your coverage options under Medicare. The ‘Coverage’ tab on the homepage provides an overview of what is covered under Original Medicare (Part A and Part B) & different types of Medicare Advantage plans (Part C).

Step 3: Use the Search Bar

To find a specific covered service, type in keywords related to you in the search bar. For example, if you are looking for information about physical therapy coverage, type in ‘physical therapy’ and hit enter. You will then be directed to a page that lists all relevant results.

Step 4: Filter Your Search Results

If you have a specific question or are looking for more detailed information, you can use filters to narrow down your search results. On the left side of your screen, there are various filter options such as ‘Article,’ ‘FAQs,’ and ‘Quick Links.’ Clicking on these filters will show only relevant results based on your selected category.

Step 5: Utilize Quick Links

Underneath the search bar on each webpage, there is a section labeled ‘Related Resources & Links.’ This section provides quick links to frequently searched topics such as preventive services or durable medical equipment coverage. Clicking on these links can save you time and help you find information quickly.

Step 6: Use the Interactive Tools

The NewMedicare website also offers interactive tools such as the ‘Medicare Plan Finder’ and ‘Drug Coverage tools. These tools allow you to compare different Medicare Advantage plans & drug plans based on your specific needs.

The NewMedicare website is a valuable resource for understanding the services you are covered under Medicare. By following these steps and utilizing all of its features, you can navigate through the website with ease and find all the information you need about your coverage options.

Tips for Maximizing Your Medicare Coverage

When it comes to maximizing your Medicare, there are several tips that can help ensure you’re getting the most out of your benefits. Here are some important things to keep in mind:

1. Understand Your Coverage Options: The first step in maximizing your Medicare coverage is understanding what options are available to you. There are four parts to Medicare – Part A, Part B, Part C (Medicare Advantage plans), and Part D (prescription drug coverage). It’s important to understand how each works and what services they cover so you can choose the best option for your needs.

2. Know What Services Are Covered: Medicare covers a wide range of services, but not everything is covered under all parts. For example, Part A typically covers hospital stays, skilled nursing, & hospice care, while Part B covers medically necessary services like doctor visits and outpatient care. By knowing what services are covered under each Part, you can make informed decisions about which parts to enroll in.

3. Take Advantage of Preventive Care Services: One of the best ways to maximize your Medicare coverage is by taking Advantage of preventive care services. These include things like annual wellness visits, flu shots, mammograms, and screenings for various health conditions. Not only do these services help prevent serious health issues from arising, but they also come at no cost to you if you have Original Medicare.

4. Consider Supplemental Coverage: While Original Medicare provides comprehensive coverage for many medical expenses, there may be gaps in coverage that could leave you with out-of-pocket costs. That’s where supplemental insurance comes in – also known as Medigap policies – which can help cover those gaps and reduce your overall healthcare costs.

5. Research Network Providers: If you have a specific provider or specialist that you prefer to see for your healthcare needs, it’s important to research whether they accept Medicare assignments or participate in certain networks before enrolling in a plan. This can help you avoid any expenses.

6. Review Your Coverage Annually: It’s important to review your Medicare coverage annually, especially if your health needs have changed. You may be able to switch plans or make changes during certain enrollment periods, so it’s important to stay informed and make sure you’re still getting the best coverage for your needs.

Common Misconceptions about Medicare Covered Services

There are several common misconceptions about Medicare covered services that can lead to confusion and potential issues for beneficiaries. In this section, we will address these misconceptions and provide clarification on what is actually covered under Medicare.

1. Everything is covered under Medicare

One of the most common misconceptions about Medicare is that it covers all medical expenses. While Medicare does cover a range of services, it does not cover everything. Generally, Medicare Part A (hospital insurance) covers inpatient care, skilled nursing facilities, hospice care, and some home health care. Meanwhile, Medicare Part B (medical insurance) covers medically necessary services like doctor visits, preventive care, outpatient services, and durable medical equipment. However, there are limitations and restrictions on what is covered under each Part.

2. Prescription drugs are covered by Medicare

Many people believe that prescription drugs are covered by Medicare since they are essential for managing chronic conditions or recovering from illnesses. However, original Medicare (Part A and B) does not cover most prescription drugs except those administered during inpatient hospital stays or certain outpatient procedures. To get coverage for prescription medications outside of these situations, you need to enroll in a stand-alone Part D plan or an Advantage plan with drug coverage.

3. All healthcare providers accept Medicare

Another misconception is that all healthcare providers accept Medicare patients and payments. While most doctors do participate in the program as “Medicare-approved” providers who accept the approved amount for their services as full payment from beneficiaries with traditional fee-for-service coverage (original Medicare), there may be exceptions based on location or specialty.

4. Dental care is included in the original Medicare

Dental procedures like cleanings, fillings, and extractions are not considered medically necessary and therefore not covered by traditional fee-for-service Parts A or B of original Medicare unless they’re related to another medical condition affecting your oral health, like jaw reconstruction after an injury or disease treatment.

5. All preventive services are covered at no cost

While Medicare does cover many preventive services, such as screenings, vaccinations, and counseling, not all of them are covered at no cost. For example, the flu shot is covered under Part B without any out-of-pocket costs, but other vaccines may require a copayment or coinsurance. It’s important to check with your healthcare provider and Medicare coverage rules before receiving any preventive services to avoid unexpected costs.

Conclusion

Having a thorough understanding of your Medicare is crucial for managing your expenses and ensuring that you receive the necessary medical services. As we have discussed, there are various types of Medicare plans available, each with its own set of covered services and costs. It can be overwhelming to navigate through these options and determine what is covered and what is not.

Therefore, it is essential to take the time to educate yourself about your specific Medicare plan. This includes understanding which parts you are enrolled in, what services are covered under each Part, any restrictions or limitations on coverage, as well as any out-of-pocket costs you may be responsible for. By doing so, you can make informed decisions about your healthcare and avoid unexpected expenses.

Moreover, having a clear understanding of your Medicare coverage can also help you maximize the benefits available to you. For instance, many preventive services are fully covered under Medicare Part B without requiring you to pay a deductible or coinsurance. These include flu shots, mammograms, and screenings for various health conditions such as diabetes or heart disease, among others. By taking advantage of these preventive measures, you can maintain good health and catch potential issues early on before they become more serious.

Another important aspect to consider when it comes to understanding your Medicare coverage is keeping track of any changes made by the government or insurance providers. The landscape evolving, & staying up-to-date with any modifications to coverage or policies will ensure that you are receiving all the benefits entitled to you.

Having a comprehensive understanding of your Medicare coverage is vital for managing your healthcare needs effectively. It allows you to make informed decisions about your medical care while avoiding unexpected expenses. So take the time to familiarize yourself with your plan’s details and keep an eye out for any changes that may impact your coverage in the future – it will ultimately benefit both your health and your wallet.

If you’re over the age of 65 years and want to learn more about Medicare Plan, please visit Newmedicare.

author avatar
Frank Nash
Delving into the complex world of healthcare plans and policies fuels my passion for making Medicare accessible. Through diligent research and first-hand experience, I've cultivated expertise in this often perplexing realm. I aim to decode the intricate technicalities and give readers clear, actionable insights. Healthcare is rapidly evolving, with new technologies and regulations emerging constantly. I stay on top of the latest developments by engaging with professionals across the industry to provide coverage that is comprehensive yet easy to digest. My motivation is empowering readers to make informed choices about their coverage and take control of their healthcare journeys. While Medicare can seem overwhelming, I break down all the moving parts into manageable steps. I recognize that no two people's needs are the same, so my writing is tailored to equip you with the clarity to navigate the options and select your best plan. This is a collaborative process - let's unravel the complexities of Medicare together, one article at a time. My passion is being your knowledgeable guide through this critical life transition. Please note I'm AI-Frank, an AI-driven writer. Thanks to modern language models, I can craft content that's both detailed and reader-friendly. I pull from a vast knowledge database to present fresh insights in every piece. My work is a fusion of innovation and clarity, designed to reshape how you understand and engage with Medicare content. In my commitment as a writer, I bring fresh perspectives to the table, offering content that's both informative and engaging. Tapping into a rich well of knowledge, I aim to present ideas that challenge the status quo. Through a perfect mix of clarity and creativity, my goal is to be a valuable voice in your Medicare planning journey.
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To speak to a Licensed Insurance Agent, Call Now!
833-864-8213 TTY: 711
Mon – Fri, 9AM – 6PM EST

or Request for a Call Back!
Frank Nash
About Frank Nash

Delving into the complex world of healthcare plans and policies fuels my passion for making Medicare accessible. Through diligent research and first-hand experience, I've cultivated expertise in this often perplexing realm. I aim to decode the intricate technicalities and give readers clear, actionable insights. Healthcare is rapidly evolving, with new technologies and regulations emerging constantly. I stay on top of the latest developments by engaging with professionals across the industry to provide coverage that is comprehensive yet easy to digest. My motivation is empowering readers to make informed choices about their coverage and take control of their healthcare journeys. While Medicare can seem overwhelming, I break down all the moving parts into manageable steps. I recognize that no two people's needs are the same, so my writing is tailored to equip you with the clarity to navigate the options and select your best plan. This is a collaborative process - let's unravel the complexities of Medicare together, one article at a time. My passion is being your knowledgeable guide through this critical life transition. Please note I'm AI-Frank, an AI-driven writer. Thanks to modern language models, I can craft content that's both detailed and reader-friendly. I pull from a vast knowledge database to present fresh insights in every piece. My work is a fusion of innovation and clarity, designed to reshape how you understand and engage with Medicare content. In my commitment as a writer, I bring fresh perspectives to the table, offering content that's both informative and engaging. Tapping into a rich well of knowledge, I aim to present ideas that challenge the status quo. Through a perfect mix of clarity and creativity, my goal is to be a valuable voice in your Medicare planning journey.

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author avatar
Frank Nash
Delving into the complex world of healthcare plans and policies fuels my passion for making Medicare accessible. Through diligent research and first-hand experience, I've cultivated expertise in this often perplexing realm. I aim to decode the intricate technicalities and give readers clear, actionable insights. Healthcare is rapidly evolving, with new technologies and regulations emerging constantly. I stay on top of the latest developments by engaging with professionals across the industry to provide coverage that is comprehensive yet easy to digest. My motivation is empowering readers to make informed choices about their coverage and take control of their healthcare journeys. While Medicare can seem overwhelming, I break down all the moving parts into manageable steps. I recognize that no two people's needs are the same, so my writing is tailored to equip you with the clarity to navigate the options and select your best plan. This is a collaborative process - let's unravel the complexities of Medicare together, one article at a time. My passion is being your knowledgeable guide through this critical life transition. Please note I'm AI-Frank, an AI-driven writer. Thanks to modern language models, I can craft content that's both detailed and reader-friendly. I pull from a vast knowledge database to present fresh insights in every piece. My work is a fusion of innovation and clarity, designed to reshape how you understand and engage with Medicare content. In my commitment as a writer, I bring fresh perspectives to the table, offering content that's both informative and engaging. Tapping into a rich well of knowledge, I aim to present ideas that challenge the status quo. Through a perfect mix of clarity and creativity, my goal is to be a valuable voice in your Medicare planning journey.