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Medicare Does Not Cover Everything.
Yes, Medicare insurance covers a lot. It is one of the most comprehensive medical insurance plans in America. It is also surprisingly affordable.
There is a wide range of benefits that are covered by Medicare. And when contrasted that with Medicare fees, the value is unquestionable. However, as great as the coverage may be, Medicare does not pay for everything.
There are several medical circumstances in which Medicare does not provide assistance. If you are in the process of acquiring Medicare, knowing what Medicare does not cover, is essential.
What Medicare Does Cover.
So what does Medicare actually cover? There are 4 parts to Medicare coverage: A, B, C, and D. (Not to be confused with Medicare Supplement plan types - A through N). Each Medicare part covers different segments of healthcare.
Most Medicare consumers enroll in part A and Part B. These two parts together, provide coverage for a majority of medical circumstances. And when part A and part B of Medicare is augmented by a Medicare supplement plan, the result is a complete, comprehensive, medical insurance plan.
Medicare Part A
Medicare Part A generally covers hospital services. This coverage also includes many benefits that are naturally associated with hospital services, such as walkers or wheelchairs. Comprehensive home healthcare services for a specific period of time, are also covered by Medicare Part A.
If you should ever need a blood transfusion, Part A also covers the cost of blood.
Note that unless your medical circumstance qualifies as an emergency, all covered medical services and benefits must be administered by a facility or entity that is part of your 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 physician services and more routine healthcare services. For example, when medically approved, Medicare Part B coverage includes:
| Benefits | Medicare Supplement Plans | |||||||||
| A | B | C | D | F* | G | K | L | M | N | |
| Medicare Part A Deductible | No | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 50% | 100% |
| Medicare Part B Deductible | No | No | 100% | No | 100% | No | No | No | No | No |
| Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Medicare Part B coinsurance or copayment | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100%** |
| First three pints of blood | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Medicare Part A hospice coinsurance or copayment | 100% | 100% | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Skilled Nursing Facility (SNF) coinsurance | No | No | 100% | 100% | 100% | 100% | 50% | 75% | 100% | 100% |
| Medicare Part B Excess Charges | No | No | No | No | 100% | 100% | No | No | No | No |
| Foreign Travel Emergency (Up to Plan Limits) | No | No | 80% | 80% | 80% | 80% | No | No | 80% | 80% |
| Out-of-Pocket Limit*** | None | None | None | None | None | None | $5,240 | $2,620 | None | None |
*Plan F is also has a high-deductible option. The F high deductible plan pays for all Medicare-covered expenses after you meet a $2240 annual deductible.
**Office copay exceptions: Some office visits may require a copayment of up to $20. Emergency room visits may require a copayment of up to $50.
***Plan pays 100% of covered Medicare costs for the remainder of the calendar year once the out-of-Pocket limit is reached.