What Does Medicare Cover for Seniors?
Understanding Medicare coverage is essential for seniors managing healthcare costs. This guide explains what Medicare covers, helping beneficiaries maximize their benefits and avoid unexpected expenses.
Medicare Part A: Hospital Insurance
Part A covers inpatient hospital stays including room, meals, nursing care, and medications during hospitalization. Most people pay no premium for Part A based on work history paying Medicare taxes.
Skilled nursing facility care is covered for up to 100 days following qualifying hospital stays. Coverage requires at least three days of inpatient hospitalization. Custodial care in nursing homes is not covered.
Home health care is covered when you meet eligibility requirements including being homebound and needing skilled services. No prior hospitalization is required for home health coverage.
Hospice care is covered for terminally ill patients choosing comfort-focused care. Coverage includes medications, equipment, nursing, and support services related to the terminal illness.
Medicare Part B: Medical Insurance
Part B covers doctor visits, outpatient care, preventive services, and medically necessary services and supplies. Monthly premiums are required, with amounts based on income.
Preventive services including annual wellness visits, many screenings, and vaccinations are covered without cost-sharing. Taking advantage of these benefits supports early detection and prevention.
Durable medical equipment including wheelchairs, walkers, hospital beds, and oxygen equipment is covered when medically necessary. Part B typically covers 80 percent after the deductible.
Outpatient therapy including physical therapy, occupational therapy, and speech therapy is covered. Home health therapy visits are covered under Part A.
Medicare Part D: Prescription Drugs
Part D covers prescription medications through private insurance plans. Coverage varies by plan, with different formularies, pharmacies, and costs. Choosing plans carefully based on your medications saves money.
The coverage gap or donut hole has been largely eliminated, though some cost-sharing still applies at higher spending levels. Catastrophic coverage limits out-of-pocket spending on drugs.
What Medicare Does Not Cover
Long-term custodial care in nursing homes is not covered. Personal care services without skilled care are not covered. Dental, vision, and hearing services are generally not covered by Original Medicare.
Medicare Advantage plans may offer additional benefits beyond Original Medicare, including dental, vision, and hearing coverage.
Getting Help with Medicare
All Seniors Foundation helps seniors understand Medicare coverage and access covered services. Maximizing your benefits requires understanding them. Contact us for Medicare guidance and to learn about covered home health and hospice services.
