Medicare: How the System Works

Medicare is divided into 4 different parts: Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D. Each part provides you coverage for a different medical expense, and having Original Medicare (along with Medicare Advantage) can quite literally be a lifesaver both when it comes to your health and your expenses. However, there are many mistakes people make when it comes to applying for Medicare, which we will be discussing today.

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What Does Medicare Cover?

The following coverage is available with each individual Medicare plan:

  • Medicare Part A: Part A covers inpatient care in a hospital or skilled nursing facility, along with nursing home care, hospice care, home health care, and blood transfusions.
  • Medicare Part B: Part B covers medically necessary services and preventive services, such as outpatient hospital care, surgeries, and some durable medical equipment.
  • Medicare Part C: Part C is Medicare Advantage, which is a plan sold by private insurers that cover what isn’t covered by Original Medicare, such as vision, hearing, and dental.
  • Medicare Part D: Part D covers prescription drugs that are covered by your insurance plan.

Medicare Part A: What is Covered

In general, Medicare Part A covers:

  • Hospital care (inpatient)
  • Limited home health services
  • Hospice care
  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehabilitation facilities
  • Long-term care hospitals
  • Mental health care
  • Part-time skilled nursing care
  • Physical therapy
  • Speech therapy
  • Occupational therapy
  • Medical social assistance
  • Part-time home health aide assistance
  • Skilled nursing services
  • Semi-private rooms
  • Meals
  • Medical supplies and equipment used in a skilled nursing facility
  • Medications received while in a skilled nursing facility
  • Dietary counseling 
  • Ambulance transportation to the closest provider is services not provided at the skilled nursing facility

Medicare Part B: What is Covered

In general, Medicare Part B covers:

  • Medically necessary services or supplies are needed to diagnose or treat your medical condition.
  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Inpatient, outpatient, and partial hospitalization for mental health services
  • Limited outpatient prescription drugs
  • Preventive services, such as health care prevent an illness like the flu or detect an illness at an early stage.

Medicare Part C: What is Covered

Medicare Part C is another name for Medicare Advantage. Medicare Advantage plans give you everything that Original Medicare (Parts A and B) offers, along with more coverage for things like hearing, vision, and dental.

Medicare Advantage can cover the vast majority of out-of-pocket costs and expenses related to services and supplies not covered by Original Medicare. 

Medicare D: What is Covered

Medicare Part D only covers prescription drugs that are covered by your insurance plan. Visit CoverageHaven today to learn about Medicare Part D and find out more about the services and items Medicare covers.

Avoid the 3 Major Medicare Mistakes

There are 3 major mistakes made every day by U.S. citizens who need coverage but don’t know their options or what they’re missing out on. These mistakes include not signing up for Medicare during the allotted time slots, assuming your coverage extends to your spouse, and thinking all prescriptions are covered.

1. Not Signing Up for Medicare Before Turning 65

If you receive social security at the age of 65, you are automatically enrolled into Medicare. However, if you do not take social security until a later age, you must enroll on your own when you turn 65. Your enrollment period begins 3 months before you turn 65, includes the month in which you turn 65, and ends 3 months after the month you turn 65. 

It is best to keep your eyes open for the open enrollment period and annual enrollment period so you can ensure you and your health are covered. 

2. Assuming Your Coverage Applies to your Spouse

Many people believe that when they turn 65, the Medicare they receive is also included for their spouse. This is incorrect – there is no group coverage, and you have to check with your insurance provider, your spouse’s insurance provider, or with an eligible work record to see if you can share coverage.

The spouse of someone with Medicare becomes eligible for their own plan when they turn 65, even if they have never worked outside the home as the spouse qualifies based on their partner’s work record. If the spouse has a disability, they may qualify at a younger age – but all of these qualifications are for their own Medicare plan. 

3. Always Make Sure Your Prescriptions are Covered!

Medicare Part D provides prescription drug coverage to many U.S. citizens, but a lot of them are unaware that not all drugs will be covered under certain insurance plans. Some drugs, such as anti-cancer, antidepressants, and HIV medications, will be covered, while others will not be, such as over-the-counter medication. 

Federal law requires that Medicare Part D must cover at least two drugs that fall under these categories:

  • Anticancer drugs 
  • Anticonvulsive treatments 
  • Antidepressants
  • Antipsychotic medications
  • HIV/AIDs drugs
  • Immunosuppressant drugs

Speak to a
Licensed Agent
1 (855) 710-0541
TTY: 711
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Learn More with Coverage Haven

To learn more about available Medicare coverage to find a plan that suits your needs, contact the professionals at CoverageHaven today or call us at 1(844) 612-0518. We are here to protect you and your future.