What Medicare covers

In order to plan for your care as you get older, it is good to know what Medicare covers and what it does not cover. You can then budget for your out-of-pocket costs. Because Medicare generally does not provide full coverage and does not cover some high-cost services, annual out-of-pocket health care costs with Medicare average $5,500. And, if you need to pay for long-term care services, unless you have Medicaid as well as Medicare, your costs will likely be much higher.

Services Medicare covers: Medicare Part A–which is generally premium-free if you or your spouse paid Medicare taxes–covers hospital, skilled nursing facility, skilled rehabilitation facility, hospice and other inpatient services. Medicare Part B–which has a standard monthly premium of about $134, though people with higher incomes pay more–covers medical services from doctors, therapists and other Medicare-certified health care providers, along with medical equipment and supplies. (To be enrolled in traditional Medicare or a commercial Medicare Advantage plan, you need Medicare Parts A and B.) Medicare Part D–which has a monthly premium that varies depending upon the plan you choose–covers prescription drugs and is optional.

Note: People who enroll in a commercial Medicare Advantage plan also have Medicare Part C.

Click on the links below to learn more about Medicare’s benefits and the services it does not cover.

• Part A
  • Hospital inpatient care
  • Skilled nursing facility services
  • Rehabilitation facility services
  • Home health services
  • Hospice care
• Part B
  • Doctor’s services
  • Preventive care
  • Physical, speech and occupational therapy
  • Hospital outpatient care
  • Durable medical equipment and supplies
  • Ambulance services
• Part D
  • Prescription drugs

Keep in mind that some costly services are expressly excluded from Medicare coverage.

Services Medicare does not cover:

• Custodial nursing home care and other long-term care services and supports, including care in an assisted living facility
• Experimental procedures and treatments, acupuncture, and most chiropractic services
• Cosmetic surgery that is not medically reasonable or necessary
• Dental care
• Hearing aids or hearing exams for prescribing or fitting hearing aids
• Vision care, except for cataract surgery and glaucoma testing
• Routine foot care
• Personal care, such as feeding, bathing, dressing or toiletting, unless you qualify for the Medicare home health benefit and need skilled services as well
• Cooking, cleaning and other housekeeping services
• Transportation services to and from the doctor’s office or hospital, except ambulances in an emergency, though Medicaid may pay for transportation services
• Care when you travel outside of the United States

If you qualify for Medicaid as well as Medicare, Medicaid may cover some of these services.

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