What Medicare Does and Does Not Cover

What Original Medicare Covers

Medicare Part A (Hospital Insurance) is offered through Original Medicare and covers hospital stays, hospice, and care in a skilled nursing facility, home health care services, and short-term nursing home care.

Medicare Part B (Medical Insurance) is offered through Original Medicare and covers preventive exam visits, annual wellness checks, laboratory tests, medical equipment, mental health care, and ambulance services.

What A/B Does Not Cover

Original Medicare, Part A and Part B, does not cover the following: annual physicals, long-term nursing home care (more than 100 days), hearing aids, dental care/dentures, or care outside of the U.S. It also does not cover cosmetic surgery, routine foot care, or acupuncture/naturopathy.

What Medicare Advantage Covers

Part C (Medicare Advantage) is offered through private companies. These plans are required to cover everything Parts A and B cover. Many also include prescription drug coverage. Some may also offer vision, hearing, and dental plans.

What Part D Covers

Part D (Prescription Drug Plans) is offered by Medicare separately from Original Medicare and covers 75% of prescription drug costs for covered drugs. Medicare sets a standard level of drug coverage, where drugs are grouped into tiers in a list called a formulary.

Tiers are based on the copayment amount for that group of drugs, often based on the name-brand cost. Generic drugs will be in lower tiers, and name-brand non-preferred drugs will be in tiers with higher copayments.

For each of the most commonly prescribed categories and classes of drugs, Part D plans must cover at least two of the drugs. Most likely, a generic and name-brand will be covered.

What Medigap Covers

Supplemental coverage, called Medigap, covers the deductibles, copayments, and coinsurance costs of Original Medicare. These plans cannot pay the Part B deductible. Premiums vary by plan because private companies offer these.

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