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Medicare Does Not Cover Everything.

Medicare may be the most comprehensive medical coverage available in the United States.  It certainly may be the most affordable.  However, Medicare does not pay for everything.  There are several medical circumstances in which Medicare coverage will be of little assistance.  In addition, because there are several different Medicare plan options, which plan covers what, can be quite confusing.  With all this in mind, let's see if we can provide some clarity.

What Medicare Does Cover.

There are 4 parts to Medicare coverage: A, B, C, and D.  (These coverages are not to be confused with Medicare plan types A-N).  Each part covers different segments of healthcare.  Most eligible Medicare consumers enroll in part A and Part B.  These two parts together, provide coverage for the majority of medical circumstances.  And when part A and part B of Medicare are augmented by a Medicare supplement plan, they provide sufficient medical insurance coverage for most Americans of Medicare eligible age.

Medicare Part A

Medicare Part A, generally covers hospital stays and services.  The coverage also includes many benefits that are naturally associated with hospital stays and services, such as walkers and wheelchairs.  If you are unable to get to a medical facility, coverage allows for home healthcare services for a specific period of time.  Part A also covers the cost of blood, should you need a blood transfusion.

Keep in mind, there are specific guidelines as to what is an approved benefit, and what is not.  In addition, unless it qualifies as an emergency, medical services and benefits must be administered by a facility or entity that is part of the Medicare network.  Some medical services may also need to be approved by your doctor, or other qualified physician.

Medicare Part B

Medicare Part B generally covers doctor services and more routine healthcare services.  This includes services such as checkups, routine annual tests, screening, and lab work.  Other services and benefits, when medically approved include:

Medicare Part C

Medicare Part C plans, are also called Medicare Advantage plans.  Advantage plans are offered by private insurance carriers that are approved by Medicare.  Medicare Advantage plans in many ways function like a traditional HMO plan.  As a subscriber, you are responsible for less costs and benefits can be more comprehensive.  However your medical benefits and services are more "managed".  In some aspects, your medical choices, as far as who you can see and where you can go, are more restricted.

Medicare Advantage plans are not for everyone.  Please give us a call if you have questions concerning Medicare part C Advantage plans.

Medicare Part D

Medicare Part D generally covers prescription drugs not covered by Part B.  Part B typically covers drugs that need to be administered by a doctor, such as an infusion or injection.  Part D generally is for the coverage of prescription drugs that you would pick up at a pharmacy.

What's not covered

Generally, medical circumstances that are not covered include:

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