Medicare Part A and Part B: What’s Covered and What’s Not

Understanding the intricacies of Medicare can be challenging, but knowing what’s covered under Medicare Part A and Part B is crucial for maximizing your benefits. Here’s a detailed guide to help you understand what each part covers, what it doesn’t, and how to make informed decisions about your healthcare.

 

Medicare Part A: Hospital Insurance

What’s Covered:

• Inpatient Hospital Care: Medicare Part A covers hospital stays, including a semi-private room, meals, general nursing, and drugs as part of your inpatient treatment. This includes care in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals.
• Skilled Nursing Facility (SNF) Care: Part A covers a limited amount of SNF care if it follows a qualified hospital stay of at least three days. This includes a semi-private room, meals, skilled nursing care, and rehabilitative services such as physical and occupational therapy.
• Home Health Care: Part A covers limited home health services if you are homebound and require skilled nursing care or therapy services. This can include intermittent skilled nursing care, physical therapy, speech-language pathology services, and continued occupational therapy.
• Hospice Care: If you have a terminal illness and your doctor certifies that you are expected to live six months or less, Part A covers hospice care, which includes pain relief, symptom management, and support services for the terminally ill and their families.

 

What’s Not Covered:

• Private-duty nursing: Part A does not cover the cost of private nurses.
• Long-term care: Also known as custodial care, long-term care is not covered unless it is part of the skilled nursing care or hospice care mentioned above.
• Personal care: Assistance with activities of daily living such as bathing, dressing, and eating, unless it is part of the home health services.
• Hospital stay beyond 90 days: After the 90th day of inpatient hospital care, you will need to use lifetime reserve days (up to 60 days over your lifetime).

 

Medicare Part B: Medical Insurance

What’s Covered:

• Doctor’s Services: Part B covers medically necessary services and supplies provided by doctors and other healthcare providers, including outpatient care and preventive services.
• Outpatient Care: This includes services that do not require an overnight hospital stay, such as certain surgeries, diagnostic tests, and physical therapy.
• Preventive Services: Part B covers preventive services to help maintain your health and detect diseases early. This includes services like flu shots, cardiovascular screenings, cancer screenings, and annual wellness visits.
• Durable Medical Equipment (DME): This includes medically necessary equipment like wheelchairs, walkers, and hospital beds prescribed by a doctor for use in your home.
• Mental Health Services: Part B covers outpatient mental health services, including counseling and therapy.

 

What’s Not Covered:

• Most dental care: Routine dental exams, cleanings, fillings, and dentures are not covered.
• Eye exams for prescription glasses: Part B does not cover routine eye exams and most eyeglasses or contact lenses.
• Hearing aids and exams for fitting them: These are not covered by Part B.
• Cosmetic surgery: Except in cases where it is needed to improve the function of a malformed body part or is necessary due to accidental injury.
• Alternative therapies: This includes acupuncture and other alternative medicine practices.

 

Making the Most of Your Coverage

Understanding the specifics of Medicare Part A and Part B can help you plan your healthcare more effectively. Here are a few tips:

 

• Review Your Needs: Assess your healthcare needs annually to ensure that your current coverage is sufficient. Consider additional coverage if necessary, such as a Medicare Advantage Plan or Medigap policy.
• Stay Informed: Keep up-to-date with any changes in Medicare coverage rules and costs. The Medicare website and your annual Medicare & You handbook are excellent resources.
• Use Preventive Services: Take full advantage of the preventive services covered under Part B to maintain your health and catch any issues early.

 

By understanding what’s covered under Medicare Part A and Part B, you can make informed decisions about your healthcare and ensure that you get the most out of your Medicare benefits.

 

 

 

Contact: Jennifer Mauldin, Mauldin Insurance Group, Lexington, SC  843-509-2462