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Medicare Solutions

 

Original Medicare Part A

What's covered?

In general, Part A covers:

Original Medicare Part B

What's covered?

Part B covers 2 types of services

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment. Part B covers things like:

What Original Medicare A & B Doesn't Cover

Medicare doesn't cover everything. If you need certain services Medicare doesn't cover, you'll have to pay for them yourself unless you have other insurance or you're in a Medicare health plan that covers them. Even if Medicare covers a service or item, you generally have to pay your deductible, coinsurance, and copayments. Some of the items and services that Medicare doesn't cover include:

  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

Many of these options may not be covered with Original Medicare, but could be covered under Medicare Advantage Plans or Medicare Supplement Plans.

We can walk you through your options in detail.

Medicare Advantage Plans - bringing better coverage (Part C)

Medicare Advantage Plans cover all Medicare services

Medicare Advantage Plans must cover all of the services that Original Medicare and will also cover additional items.

In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care. The plan can choose not to cover the costs of services that aren't medically necessary under Medicare.

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

Original Medicare covers hospice care even if you're in a Medicare Advantage Plan.

If you're not sure whether a service is covered, check with your provider or health plan provider before you get the service.

We can walk you through all of the plan options currently available.

Medicare Part D - Prescription Drugs

What drug plans cover

Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary).

Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost. A drug in a lower tier will generally cost you less than a drug in a higher tier.

Medicare Supplements

Medicare Supplement plans are also called Medigap. They are designed to work with Original Medicare Parts A and B. They help pay for some health care costs not covered by Original Medicare, such as deductibles and coinsurance. You must have Medicare Parts A and B to qualify for a Medicare Supplement plan. These plans are offered by private insurance companies in your state. People with Original Medicare and a Medicare supplement can choose from any of the stand alone Part D prescription plans to pay for their drugs.

Note: you can’t enroll in both a Medicare Supplement plan and a Medicare Advantage plan.

All reference material found on this page is sourced from www.medicare.gov.