Original Medicare: Find Out Which Medical Services Are Covered And Which Are Not

Original Medicare: Find Out Which Medical Services Are Covered And Which Are Not

What does Medicare cover? That’s a question I often hear among those that are barely new to Medicare –and even, among some of the most seasoned beneficiaries.

This surprises me, as most of the Medicare beneficiaries overlook various benefits they pay for –especially preventive benefits that could contribute to a healthier life.

To understand which benefits are included with Medicare you should know about Original Medicare and your other choices, such as Medicare Advantage or Medicare Supplemental Plans.


Let’s start with the basics:


What does Original Medicare include?


Original Medicare is the traditional choice for most beneficiaries. It’s conformed by Part A and Part B, each part covers different medical needs.

But both parts are necessary, if you’re about to withstand a medical procedure in a hospital you will probably need Part A to cover you while you remain at the clinic and your Part B for services and supplies for the procedure (as well as previous preventive services for early stages.)


What does your Part A cover?


Your Part A covers services related to inpatient coverage: care you receive at a hospital, at a nursing facility care or at home –included hospice coverage

This includes:


  • Rooms (semi-private unless medically necessary)
  • Meals
  • General Nursing
  • Prescription Drugs (while receiving inpatient coverage)


And how much will a Part A coverage cost you?


  • $1,316 deductible for each benefit period
  • $0 coinsurance (Days 1-60)
  • $329 coinsurance (Days 61-90)
  • $658 coinsurance (Days 91 and more per each “lifetime reserve day”)


What does your Part B cover?


On the other hand, your Part B covers services and supplies you need when treating a condition such as diabetes. You also receive coverage for preventive services such as tests, screenings, shots and even counseling for conditions as depression, obesity, nutrition and cardiovascular disease.

Also, your Part B includes:


  • Ambulance services
  • Mental health (both inpatient and outpatient coverage)
  • Some outpatient prescription drugs (not as a full standalone Prescription Drug Coverage.)
  • Medical equipment


And how much will a Part B coverage cost you?


  • Depending on your individual or joint tax return, you can pay a premium of $134 up to $428.60
  • A $183 deductible, and a 20% of the Medicare approved amount once you’ve met your deductible


How to check for a specific test, item or service?


If you head to the page you will find a tool that allows you to search for a service you need –after you find the service you’re looking for you have to search for a hospital or professional that accepts Medicare.


What if a service I need is not covered by Original Medicare?


As I mentioned at the beginning, there are 2 choices to Original Medicare: Medicare Advantage and Medicare Supplemental Plans (Medigap.)

Medicare Advantage could offer you what your Original Medicare offers plus other benefits such as dental or vision coverage, while Medigap will help you pay for some of your Original Medicare costs.


So if you find you need more health benefits or extra help with your Medicare expenses you could consider changing your current Medicare policy during the Medicare Open Enrollment that ends next week.

That’s right, the Medicare Open Enrollment ends on December 7 and this is your last chance to enroll unless you want to spend a whole year without those extra benefits.

Tony Feijoo

Antonio’s career as a marketing consultant began in 1989 advising multi-national companies on strategies to reach US Hispanic households and expanding market reach for US companies in Latin America. In 2003 he consulted for the health insurance industry and became licensed in 2007, opening an insurance agency in South Florida. He is passionate about healthcare and the adverse impact costs have on the average American family. He is a member of HAFA, the Florida Chain, the Florida Alliance and believes that free market economics coupled with common sense regulations will provide the answers to a stable and fair health insurance system in our country

No Comments

Post a Comment