What Medicare Health Plans Cover

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To understand what coverage plan would work best for you, you have to figure out what you need most when dealing with your health. The Medicare Health Plans are designed to be affordable and flexible for your needs. You can choose to pay more or less out of pocket and add on additional plans that offer services that are unique to your healthcare requirements. You can choose to get the Original Medicare or the Medicare Advantage Plan, both of which offer different coverage options.

Medicare Part A Coverage

You receive hospital and medical facility inpatient care when you enroll for Part A coverage. This may not be long-term care, however. You can receive hospice care for some home healthcare services. The plan is automatic, and you are pre-enrolled if you are receiving Social Security benefits. If you don’t already receive these benefits, you can enroll through the Social Security website. 

Medicare Part A Costs

Most people can receive this format of healthcare for free. This is because they paid Medicare payroll tax while working a full-time job. Otherwise, the deductible for Medicare Part A is $1,484. The daily coinsurance cost for lifetime reserve days is $742. Dail coinsurance costs $371 for the 61st to 90th day. For the skilled nursing facility coinsurance, it is $185.50 for days 21 through 100. 

Medicare Part B Coverage

This portion of Medicare covers mostly doctor visits and outpatient care. You can also include mental health coverage, ambulance rides, and the use of some medical equipment. Some of the prescription drugs can be included if you need drug coverage. It is great for medical services and preventative healthcare. Whatever is not covered under the deductible Medicare will cover if you pay at least a 20% portion. 

Medicare Part B Costs

The price for the standard monthly premium is $148.50 with a deductible of $203. The price is more-expensive if your income is higher than $88,000 as an individual or $176,000 as a married couple. 


Medicare Part C Coverage

Also called Medicare Advantage, this coverage plan is a combination of Plan A and Plan B. You purchase this coverage through private insurers that have had their programs government certified. This is for people who want specific forms of coverage and a lower premium. However, if your health were to fail, you would have to pay more expenses. Because out-of-pocket costs can get pricy, there is a limit set on these plans. The benefit is that you don’t have to get supplemental insurance or pay for a Medigap plan, which mostly involves deductibles, coinsurance, copay, and more. The Part C coverage is very flexible and can include vision, hearing, and dental care as well. 

Medicare Part C Costs

The costs of this plan are highly dependent upon the private insurance company you decide to work with. You would have to select which company has prices and coverage combinations that work in your best interests. 

Medicare Part D Coverage

This is a supplemental coverage plan which includes drugs. You can enroll in this plan if already enrolled in Part A or Part B. You can also receive subsidies in the event you don’t have prescription drug coverage in the original Medicare plan. This is also dependent on the type of prescription drugs that you require.

What is Not Covered By Medicare?

Unfortunately, long-term care or custodial care is not covered by Medicare. If you need this type of coverage, Medicaid is available. This program helps cover custodial costs for those who are low-income with few assets. Medicare also won’t include eyeglasses or eye exams. If you need dental care, it may cover some cases but in most, it does not cover this service as well. Dentures and hearing aids are not included in this plan. If you need message therapy, this won’t be paid for. Acupuncture is also not covered though it is medicinal in nature. Lastly, cosmetic surgery is not included because it is not considered a healthcare remedy. 

Medigap Coverage 

If you need supplemental insurance, Medigap will cover additional healthcare needs in the form of a 2nd insurance policy. You can buy this to cover any costs that don’t fit into Medicare Part A and Part B. This includes coinsurance and any healthcare costs for when you to travel outside the US. This won’t help with long-term care coverage, however. Other items not covered are private nursing healthcare, dental, vision, hearing aids, or prescription drugs. 

What Coverage Plan Will Work for Me

You have to know what you can’t live without and what you can manage paying out-of-pocket on your own. For things you can’t live without but are not covered under the Original Medicare or Part C, you can get the Medigap coverage. Knowing in detail what coverage plans will have the features you need will make it far easier for you to choose. For example, if you absolutely require prescription drugs, you have to add on Part D so that you can stay compliant with your doctor’s recommendations. If adding on a policy is too expensive and you can’t do without Part A or Part B, then you can enroll in Part C, which also covers some prescription drugs. If you need hospital visits for more intense medical care, you will need Part A. However, if all you need is occasional checkups, then you would only pick Part B. If you have Medigap, you can cover things you typically need, such as dental or vision, that isn’t typically covered under the original plan. Often the plans offered by private insurers take into account flexibility and affordability. Planning ahead and knowing exactly what you need will aid you in patching together a plan that works best for you. 

Start Your Enrollment Plan Today

To get started, you can read more here to learn more about the process. If you require additional help, a representative can help guide you through the difficult process of selecting a program that is specifically tailored to your needs. 

*References

https://unsplash.com/photos/GnLuuG9crEY

What Medicare covers

Guide to Medicare

What Is Medicare, and What Does It Cover?

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