Medicare forms the foundation of health care coverage for Americans age 65 and older. A portion of Medicare coverage, Part A, is free for most Americans who worked in the U.S. and thus paid payroll taxes for many years. Part A is called “hospital insurance.” If you qualify for Social Security, you will qualify for Part A.
Part B, referred to as medical insurance, is not free. You pay a monthly premium for Medicare Part B. Part B is the portion of Medicare that more closely resembles what you may think of as traditional health insurance. Let’s take a look at what Medicare Part B covers.
You usually will not pay extra for preventive services, as long as the health care provider accepts assignment. Some of the preventative services covered are:
- Alcohol misuse screenings
- Bone density measurements
- Cardiovascular disease screenings
- Cancer screenings (such as for cervical, colorectal, prostate, etc.)
- Depression screenings
- Diabetes screenings
- Flu shots
- Glaucoma tests (if you are considered to be at high risk for this disease)
- Pneumococcal shot
- A yearly “wellness” visit
This is not a complete list of preventative services covered by Medicare Part B. Additional services not listed are also available.
Other Medically Necessary Services
There are other items covered by Part B in addition to preventive services. For many of these items, a deductible may apply, and you may pay 20% of the Medicare-approved cost. There is no yearly limit on how much you may have to pay in out-of-pocket costs for health care services.
For this reason, many people also have a Medicare Supplement policy, sometimes called a Medigap policy, to help cover the “gaps” in coverage. These supplemental policies may be able to provide more complete coverage with the assurance of annual out-of-pocket cost limits.
Here are some other items covered by Part B which may be subject to the deductible and co-pay:
- Ambulance services
- Cardiac rehabilitation
- A portion of outpatient chemotherapy
- Implanted defibrillator
- Diabetes supplies
- Durable medical equipment (like oxygen equipment, wheelchairs, walkers)
- Certain types of medically necessary home health services
- Kidney dialysis and supplies
- Physical therapy
- Second surgical opinions
- Tests such as MRIs, CT scans, EKG/ECGs, and a CPAP trial (for up to three months) if you have been diagnosed with obstructive sleep apnea
Medicare Part B also covers most lab services such as blood tests, urinalysis, and tests on tissue samples. Usually, you will not pay extra for these lab services.
What Isn't Covered By Medicare Part B
Most dental care, including dentures, is not covered under any portion of Medicare Parts A and B. Eye examinations related to prescribing glasses (as opposed to an illness or issue), cosmetic surgery, hearing aids, fitting exams related to hearing aids, and concierge services are not covered by Medicare Parts A and B, either.
Many people are not aware that Medicare will not cover long-term care. Also known as "custodial care," long-term care is non-medical care related to the six activities of daily living. For example, many people need help later in life with activities like bathing, dressing, preparing meals, and using the restroom. This type of care is not covered under Medicare.
This lack of coverage isn't unique to Medicare Parts A and B. According to the Centers for Medicare & Medicaid Services, most health insurance plans don't cover these services. That includes Medigap coverage.
Medicare Part A does cover a portion of costs for skilled nursing home care, but only as an inpatient. Many people need skilled nursing home care due to a disability or disease, but they don’t meet the minimum hospital stay requirement. If that describes your situation, it means you cannot count on Medicare Part A or Part B to cover nursing home or long-term care expenses.
However, if your income and assets are low enough, you may become eligible for Medicaid. If you are eligible for Medicaid and your nursing home or long-term care is deemed medically necessary, then Medicaid (not Medicare) may cover the cost.