Medicare Coverage

Understanding what Medicare does and doesn’t cover is key to making the right healthcare decisions. Whether you’re planning ahead for yourself or helping a loved one, we’re here to break it all down in simple terms.

Covered Services and Benefits

Medicare is designed to cover medically necessary services that help diagnose, treat, or prevent illness. Coverage is divided into different parts:

Medicare Part A – Hospital Insurance

Most people get Medicare Part A for free. This covers hospital-related care when you need to be admitted for treatment:

• Hospital Stays – Covers semi-private rooms, nursing care, meals, and medical services in a hospital.
• Skilled Nursing Facility (SNF) Care – Covers short-term rehabilitation after a hospital stay (but not long-term nursing home care).
• Home Health Care – Covers skilled nursing care, therapy, and home health aide services if medically necessary.
• Hospice Care – Covers comfort care for terminally ill patients, including pain management and counseling.

Medicare Part B – Medical Insurance

Part B has a monthly premium, and you pay 20% of most services once you’ve met the deductible. This covers doctor visits, outpatient care, and preventive services:

• Doctor Visits and Outpatient Care – Covers visits to doctors, specialists, outpatient surgeries, and lab tests.
• Preventive Services – Covers screenings, vaccines, and annual check-ups to catch health issues early.
• Mental Health Services – Covers therapy, counseling, and certain mental health treatments.
• Durable Medical Equipment (DME) – Covers wheelchairs, walkers, and other medical equipment prescribed by a doctor.

Medicare Advantage (Part C) – All-in-One Coverage

Costs for this option vary widely by plan. Some even have $0 monthly premiums, but still require you to pay your Part B premium. In terms of coverage, Medicare Advantage plans replace Original Medicare (Parts A and B):

• Includes everything covered by Medicare Part A and B.
• Often includes prescription drug coverage (Part D).
• May offer extra benefits like dental, vision, and hearing care.
• Requires use of in-network doctors and hospitals– you can’t see anyone, anywhere.

Medicare Part D – Prescription Drug Coverage

The cost for Medicare Part D varies depending on your chosen plan. Most have a monthly premium and an annual deductible. This covers prescription medications through private insurance plans:

• Covers most common prescription drugs (varies by plan).
• $2,000 yearly out-of-pocket cap starts in 2025—after that, Medicare covers all drug costs.
• Helps lower costs of brand-name and generic medications.

Part D plans vary by state and provider. You’ll choose a plan based on your specific prescriptions and pharmacy needs.

Services Not Covered by Medicare

Medicare covers a lot, but not everything. It’s common to add supplemental coverage or pay out of pocket for these services:

Service	How to Get Coverage
Long-Term Care (Nursing Homes, Assisted Living)	Medicaid may help for those who qualify, or private insurance
Routine Dental Care (Cleanings, Fillings, Dentures)	Some Medicare Advantage plans cover dental
Vision Exams and Eyeglasses	Medicare Advantage or separate vision plans
Hearing Aids & Exams	Some Medicare Advantage plans cover hearing
Cosmetic Surgery	Not covered unless medically necessary
Most Chiropractic Care	Limited coverage for spinal adjustments
Routine Foot Care	Only covered for certain medical conditions like diabetes
Acupuncture and Alternative Therapies	Medicare covers acupuncture only for chronic lower back pain
Medical Care Outside the U.S.	Medicare usually doesn’t cover healthcare outside of the U.S. except in limited emergencies

Some Medicare Advantage plans or Medigap policies can help cover some of these gaps. It’s essential to thoroughly review your options if you need coverage for these services.

If you need help comparing and choosing the best policy, get in touch with our Medicare advisors today at (888) 556-3037.

Understanding Preventive Care and Screenings

Medicare fully covers many preventive services to help catch health problems early and keep you healthy, meaning you pay nothing. It’s always in your best interest to utilize these benefits—an ounce of prevention is worth a pound of cure, after all.

Preventive Services Medicare Covers for Free

• Annual Wellness Visit – A yearly check-in to assess your health and prevent future issues.
• Screenings for Cancer, Diabetes, and Heart Disease – Includes mammograms, colonoscopies, cholesterol tests, and more.
• Flu, Pneumonia, and COVID-19 Vaccines – Protects against common illnesses.
• Bone Density Tests – Helps detect osteoporosis in at-risk individuals.

How to Use Your Preventive Benefits

• Your “Welcome to Medicare” visit is available within the first 12 months of enrolling in Part B.
• Your Annual Wellness Visit is covered once every 12 months after that.
• Certain screenings are covered based on your age, medical history, or risk factors.

Preventive care is one of the best ways to stay healthy and reduce future medical costs. Be sure to schedule these visits and take advantage of your Medicare benefits!

Need Help Making Sense of Medicare Coverage?

Medicare covers a lot, but it doesn’t cover everything—and figuring out the gaps can feel like a huge research project you never signed up for.

The good news? You truly don’t have to do this alone.

If you’re unsure about your coverage, wondering if you have the right plan, or just need clear, honest answers, we’re here to help. No pressure, no confusing jargon—just real guidance from people who care about getting you the right coverage.

Let’s find the best Medicare plan for you, together. Call us today at (888) 556-3037 to speak with one of our Medicare advisors.