What’s Covered by Medicare

Learn about the two main ways to get your Medicare coverage—the original Medicare or Medicare Advantage Plan part.

But to give an overall view of things, Medicare Part A covers hospitalization insurance, inpatient hospital care, skilled nursing facility, hospital lab test surgery, and home health care.

Now Medicare Part A comes on your Medicare card. The red, white and blue card has your name on top, has your Medicare claim number, and it’ll say part a with an effective date and part B with an effective date.

If you remember from our previous episodes, Medicare Part A is the hospital coverage and you pay as you are for that unless you didn’t work 40 quarters in your life or had a spouse that worked 40 quarters of their life. But essentially, most people pay $0 million for Part A.

Now what does Part B cover? Part B covers your doctor and other health care providers, services, and outpatient care.

Part B also covers durable medical equipment, home health care, and some preventative services. Also on your Medicare card it’ll say the second line, the last line it says part B medical. That’s your doctor’s coverage.

If you have:

• Under $170,000 as a couple in income or modified adjusted gross income
• $85,000 as a single modified adjusted gross income

Then you’ll only pay $135.50 for the Medicare part B.

Obviously, if you have a higher income, you pay a higher premium as well and there are five different levels for your interrelated adjustment. For people that are making over those amounts, they’ll pay more for their part B coverage.

So what do different Medicare health plans cover? Medicare health plans include:

• Medicare Advantage
• Medicare Savings Accounts, or NSAs
• Medicare Costs Plans
• PACE which stands for Preventative and Screening Services(Part B covers many preventative services)

When it comes to items and services that aren’t covered by Medicare Part A or Part B, you’ll have to pay for items and services yourself unless you have other insurance. If you have a Medicare health plan, your plan may cover those.

The Medicare coverage on other tasks, items and services list only includes test items and services that are covered no matter where you live.

If your test item or service listed “Talk to your doctor or other healthcare providers,” they can help you understand why you need certain tests, items or services, and if Medicare will cover them. For the complete list, check it out here.

If you checked that out, the list is overwhelming and that’s why you need an expert guide to help you go through the list.

Obviously, you won’t require everything there, but if you have things that you need help with as well as with any research necessary, that’s where working with an independent Medicare agent can definitely benefit you.

And you also have to know that although the list outlined in the Medicare site is extensive, there are a couple of misconceptions on what Medicare really covers. So for instance, in the Medicare site, there’s a page for long-term care, but I always tell people that long-term care isn’t really covered.

In the original Medicare, you pay 100% of non-covered services including most long-term care which is defined as a range of services and support for your special personal care needs.

Most long-term care isn’t really medical care. Instead, most long-term care are basic personal tasks of everyday life sometimes called activities of daily living.

Now this is where it gets confusing. If you base on the Medicare website, you’ll see that long-term care is included in the test items and services that are covered no matter where you live. However, it just says it’s covered but if you click the link and look at the description on the site, it then says it isn’t covered.

So that’s what I mean when I say confusing. You’d have to dig down deeper to find out what they’re really saying because at face value, it can be interpreted differently.

But because I’m a Medicare expert, I knew that long-term care or custodial care wouldn’t be covered under original Medicare.

This is just one example but we’ll have plenty of future videos that will help you understand this whole process.