Medicare won't pay for 24-hour home care or for meals delivered to your home. Nor does it cover help for what are called “activities of daily living”, such as bathing, dressing, going to the bathroom, eating or moving from one place to another in the house. Original Medicare, or Parts A and B, is also known as “traditional” Medicare or “fee-for-service Medicare.” What does original Medicare cover? Usually, Part A covers inpatient care, while Part B covers outpatient care. What doesn't Medicare cover? Parts A and B don't cover long-term care in nursing homes, acupuncture, or other services. Medicare, the government's health insurance program for adults 65 and older and for younger people with certain disabilities, goes by many names.
One term you may hear often is “original Medicare.” Original Medicare refers to parts A and B of Medicare, which form the basis of Medicare coverage. It may also be called “traditional Medicare” or “fee-for-service Medicare”. Original Medicare plans are usually offered by a private company authorized by Medicare to provide benefits to members. If you're trying to decide if original Medicare is right for your healthcare needs, the first step is to understand the extent of the coverage it offers.
Traditional Medicare covers treatment from a doctor, hospital, skilled nursing facility, or outpatient treatment clinic if Medicare allocations are accepted. Does original Medicare pay for prescription drugs? No, it doesn't. If you have traditional Medicare, you must purchase a separate Medicare Part D plan for prescription drug benefits. Some people also choose to buy a Medigap plan to offer supplementary coverage to the original Medicare.
Medigap can help cover out-of-pocket expenses, such as deductibles and coinsurance, to make healthcare costs more manageable. Original Medicare offers a wide range of coverage, including most medically necessary services and supplies in a variety of healthcare settings. When evaluating your Medicare options, it's important to know what types of health care services are not included in Parts A and B (see table below). In these cases, you'll have to pay for services out of pocket, unless you have another type of health insurance.
Looking at all of your Medicare options on your own can be a challenge. Therefore, we recommend that you contact your local State Health Insurance Assistance Program (SHIP). You will be connected to a trained counselor who will provide you with free, practical guidance on your Medicare options. They'll guide you through your options, answer any questions you have, and help you make informed coverage decisions.
Sorting through the various Medicare coverage options can be confusing, and choosing the wrong plan could cost you much more in the long run. Contact your local State Health Insurance Assistance Program (SHIP) for detailed, individual advice on insurance and Medicare assistance. Annual or routine physical exams are not covered by Medicare. This may seem like a lack of vision, as annual physical exams are usually recommended as a preventive measure to prevent more serious medical problems through early detection. Medicare does cover a Medicare wellness visit, also called a wellness exam.
This type of consultation is an evaluation of your general health and well-being. Medicare Part B (health insurance) helps cover the cost of medically necessary durable medical equipment if a doctor prescribes it for use at home. In general, Medicare Part A (also known as hospital insurance) can cover inpatient hospital care, care in nursing homes, care in nursing homes, palliative care, and home health care. For example, Medicare doesn't cover breast augmentation for cosmetic reasons, but it does cover reconstructive surgery after a mastectomy. Part A (hospital insurance) helps pay for inpatient hospitalizations, stays in skilled nursing facilities, surgeries, palliative care, and even some care of home health.
Medicare provides coverage for some skilled nursing services, but not for custody care, such as help with bathing, dressing, and other activities of daily living. If you save money on an HSA before you sign up for Medicare, you can make tax-free distributions at any age to reimburse for exams, eyeglasses, contact lenses, prescription sunglasses, and other out-of-pocket expenses related to eye care. Original Medicare usually doesn't cover the cost of a nursing home, assisted living, or long-term care facility. Medicare covers most of the healthcare needs of older Americans, from hospital care and doctor visits to laboratory tests and surgery. Some Medigap policies cover certain medical costs abroad and generally pay 80 percent of the billed charges for specific medically necessary emergency care you receive outside the U.S.
UU. Medicare covers a wellness visit once every 12 months (a full 11 months must have passed since your last visit), and you are eligible for this benefit after receiving Part B for at least 12 months. One reason is that traditional Medicare and Medicare Advantage plans don't cover the cost of long-term care in nursing homes and assisted living facilities. Medicare Part B (also known as health insurance) provides coverage for preventive and medically necessary care services.
In addition, the Department of Health and Human Services finalized rules in April 2024 to review how Medicare Advantage customers obtain prior approval for care.
