What medical services does Original Medicare cover?

Original Medicare is a federal health insurance program that primarily covers medical services for people aged 65 and older, as well as those with certain disabilities such as ALS, and end-stage renal failure.

Original Medicare is made up of only two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Original Medicare does not cover all medical services. For example, it does not cover most prescription drugs, routine dental care, eye exams, hearing aids, gym memberships, or long-term care. To get coverage for these services, you may consider enrolling in a Medicare Advantage plan, purchasing a Medigap Supplement, or purchasing a separate stand-alone prescription drug plan.

Part A and Medicare Part B coverage are the only benefits covered under Original Medicare. Inpatient hospitals, skilled nursing facilities, hospices, and home health services are among the Part A benefits. A doctor's or non-physician professional's outpatient and professional services, clinical lab services, durable medical equipment, preventive care, and other outpatient medical services are all covered under Part B benefits.

Medicare Part A covers Medicare Part A Coverage inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services.

Medicare Part B covers a wide range of medical services, including doctor visits, some preventive care, diagnostic tests, outpatient services, ambulance services, durable medical equipment, mental health care, and some prescription drugs.

Medicare Part A and Part B provide coverage for a range of medical services. Here's an overview of the services covered by each part:

Medicare Part A (Hospital Insurance) covers:

• Inpatient hospital care: This includes semi-private rooms, meals, general nursing, and other hospital services and supplies.
• Skilled nursing facility care: Coverage includes skilled nursing care, rehabilitation services, and other necessary services and supplies following a qualifying hospital stay.
• Hospice care: coverage includes pain relief, symptom management, and supportive services for individuals with a terminal illness.
• Home health care: coverage includes intermittent skilled nursing care, therapy services, and home health aide services in your home.

Medicare Part B (Medical Insurance) covers:

• Doctor visits: coverage includes visits to doctors, specialists, and other healthcare professionals.
• Outpatient services: coverage includes medically necessary services received outside of a hospital, such as diagnostic tests, lab services, and preventive services.
• Preventive services: coverage includes screenings, vaccinations, and annual wellness visits.
• Durable medical equipment (DME): coverage includes medically necessary equipment like wheelchairs, walkers, and oxygen equipment.
• Ambulance services: coverage includes transportation by ambulance when it's medically necessary.
• Outpatient mental health services: coverage includes counseling, therapy, and psychiatric services.
• Limited outpatient prescription drugs: Original Medicare generally does not cover most prescription drugs, except for certain medications administered in a healthcare setting (e.g., chemotherapy drugs).

It's important to note that Original Medicare Part B typically covers 80% of the approved amount for covered services, and you are responsible for the remaining 20%, in addition to any deductibles, copays, and coinsurance. Medicare Part B Coverage To help with these out-of-pocket costs, individuals often choose to enroll in additional coverage options, such as Medicare Supplement Insurance.