Medicare Coverage

There are many different layers that make up Medicare coverage, and it may be easy to get confused about what’s included. Understanding what each component of Medicare covers is important to selecting the right health insurance coverage for you. 

Use the guide below to see what’s covered by each part of Medicare.

Doctors review medical charts

Part A coverage

Medicare Part A provides coverage for hospital expenses. These include:

Inpatient hospital care (for acute care hospitals, critical access hospitals, long-term care hospitals, inpatient rehab facilities, inpatient care for clinical research studies and inpatient mental health care).

What’s covered:

  • Semi-private rooms
  • Hospital meals
  • Drugs administered as part of your hospital care
  • General nursing services
  • The use of hospital supplies

Skilled Nursing Facility (SNF) care

What’s covered:

  • Semi-private rooms
  • Meals
  • Skilled nursing care
  • Medications
  • Supplies and equipment used in the facility
  • Physical and occupational therapy
  • Speech-language pathology services
  • Dietary counseling
  • Ambulance transportation (certain restrictions apply)

Hospice care (inpatient or at-home; certain restrictions apply)

What’s covered:

  • Doctor services
  • Nursing care
  • Medical equipment and supplies
  • Medications prescribed for pain relief or symptom control
  • Physical and occupational therapy
  • Speech-language pathology services
  • Social work services
  • Dietary counseling
  • Grief and loss counseling for the family
  • Short-term respite care

Part B coverage

Medicare Part B is known as “medical insurance” and covers services like doctor visits, surgeries and preventive care. Other services covered by Part B include:

Clinical research studies

What’s covered:

  • Room and board
  • Operations to implant tested items
  • Treatment of side effects or complications resulting from the study

Ambulance services

What’s covered:

  • Transportation to or from a hospital or skilled nursing facility only when other forms of transportation could jeopardize the health of the patient
  • Transportation during an emergency situation such as a state of shock, unconsciousness or heavy bleeding
  • Transportation when skilled medical treatment is needed during transportation
  • Air transportation when a health condition requires attention that can’t be provided by ground transportation

Durable medical equipment (DME) (medically necessary equipment prescribed by a doctor that is used in your home and is expected to last at least three years).

What’s covered: 

  • Blood sugar monitors and test strips
  • Canes
  • Commode chairs
  • Crutches
  • Lifts
  • Pumps
  • Walkers
  • Oxygen equipment
  • Sleep apnea devices
  • Wheelchairs
  • And more

Mental health treatment (inpatient and outpatient)

What’s covered:

  • Psychiatrists
  • Clinical psychologists
  • Clinical social workers
  • Clinical nurse specialists
  • Nurse practitioners
  • Physician assistants
  • One depression screening per year
  • Family counseling
  • Medication management
  • Psychotherapy
  • Psychiatric evaluations
  • Partial hospitalization

Part C coverage

Medicare Part C is a little different than Part A or Part B (Original Medicare). Part C is known as “Medicare Advantage” and is an alternative to Original Medicare. Instead of receiving Medicare benefits from the federal government, you receive them from a private health insurance plan.

Medicare Advantage plans must provide at least the same coverage as Part A and Part B together but can do so under different terms, rules and costs.**

There are hundreds of Part C plans available. In addition to providing the same benefits as Part A and Part B, these plans may also include additional coverage such as:

  • Dental
  • Vision
  • Hearing
  • Prescription drugs

Part D coverage

Medicare Part D is the Medicare program’s prescription drug component. You can receive drug coverage through a Medicare Advantage plan that provides it, or you can add a standalone Prescription Drug Plan (PDP) to Original Medicare or a Medicare Advantage plan that doesn’t offer prescription drug coverage. Like Medicare Advantage, PDPs are sold by private insurers. Costs, terms and types of medication covered can vary.

Questions about Medicare coverage?

To learn more about Medicare coverage and to find a Medicare Advantage plan or Prescription Drug Plan in your area, call a licensed insurance agent at   TTY Users: 711.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

**Medicare Part A still covers hospice care, even if you are enrolled in a Medicare Advantage plan.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.