Understanding Medicare Coverage: What Is Included?

Medicare is a federal health insurance program designed primarily for individuals aged 65 and older. It also provides coverage for people with certain disabilities and those suffering from end-stage renal disease, a condition involving permanent kidney failure.

Managed by the Centers for Medicare & Medicaid Services, Medicare helps cover various health-related costs. Similar to Social Security, it is an entitlement program that most Americans qualify for if they've contributed through work and taxes over the years.

Part A – Hospital Coverage

Medicare Part A provides hospital insurance, covering inpatient care, home health services, skilled nursing facilities, and hospice. Most beneficiaries do not pay premiums for Part A if they've worked for at least ten years and paid Medicare taxes. For those with less work history, a monthly fee applies. Coverage typically includes up to 90 days in hospital and 100 days in a skilled nursing facility, with an additional 60 reserve days for extended stays.

Part B – Medical Services

This part covers outpatient medical expenses such as doctor visits, lab tests, x-rays, blood work, diabetic supplies, and outpatient hospital care. Beneficiaries pay a monthly premium, which can be higher based on income. Medicare Part B helps reduce costs for routine medical services, and Medicaid can assist those with low income to cover Part B premiums.

Part C – Medicare Advantage

Offered by private insurers, Medicare Advantage combines Part A and B benefits into a single plan. Enrollment requires eligibility for Parts A and B. These plans often include additional coverage like dental, vision, hearing aids, and sometimes travel-related healthcare. Many Advantage plans also include prescription drug coverage, known as Medicare Advantage Prescription Drugs plans.

Part D – Prescription Drug Coverage

Part D provides coverage for prescription medications. Each plan has a formulary—a list of covered drugs organized into tiers, with lower tiers generally costing less. Notably, certain drugs are not covered under Part D, including weight management drugs, cosmetic or hair growth treatments, fertility medications, erectile dysfunction drugs, and over-the-counter medicines.