What Does Medicare Cover?

What Part A & Part B (often referred to collectively as “Original Medicare”) Doesn't Cover

Original Medicare (Parts A and B) covers many medical and hospital services, but it doesn't cover everything. Many people are surprised to learn that prescription drugs aren't covered. Prescription drug coverage can be purchased through Medicare Part D, but it's not provided by Part A or Part B. You may have to pay for these costs yourself unless you have other insurance that covers them. Some Medicare Advantage (Part C) plans may help with certain services not covered by Original Medicare, such as prescription drugs.

Here are some other services that are not covered by Original Medicare:

• Dental exams, most dental care, or dentures
• Routine eye exams, eyeglasses, or contacts
• Hearing aids or related exams or services
• Most care while traveling outside the United States
• Help with bathing, dressing, eating, etc. (custodial care)
• Comfort items such as a hospital phone, TV, or private room
• Long-term care
• Cosmetic surgery
• Most chiropractic services
• Acupuncture or other alternative treatments
• Routine foot care

Medicare Advantage (Part C) Covers

Medicare Part C also called Medicare Advantage, is an alternative to Original Medicare. These plans combine the coverage of Parts A and B into one plan. They often include prescription drug coverage and other services such as dental, vision and hearing care. Plans may vary with in-network providers.

Medicare Part D Covers

Medicare Part D offers prescription drug coverage. It helps pay for medications your doctor prescribes. You can get a standalone Part D plan or get a Medicare Advantage plan that includes drug coverage.

Medicare Supplement Insurance: Medigap

Medicare Supplement Insurance, also known as Medigap, helps pay some out-of-pocket costs that come with Original Medicare. There are 10 Medicare supplement insurance plans standardized by the federal government. Each is labeled with a letter: A, B, C, D, F, G, K, L, M, and N.

Every plan with the same letter offers the same benefits, no matter what state it's offered in or by which insurance company. The difference is that the level of coverage between plan letters varies. There are standardized plans that cover all Medicare deductibles, copayments and coinsurance, while others require out-of-pocket payments.

Medicare supplement plans provide nationwide coverage. While you may enroll in a plan at any time, you may be denied coverage or charged more based on your health history or if you enroll after the Medigap Open Enrollment Period ends.

How do I choose one or more Medicare plans?

Think about your needs so you can see how different coverage options might work for you. Answering the following questions can help you get started.

How is your health?

• How often do you go to the doctor?
• What health problems do you have?
• What medications do you take regularly?

What are your preferences?

• Which doctors, hospitals and pharmacies do you like to go to?
• How important is it for you to have access to health care while traveling?
• What other coverage do you have, such as an employer or retiree plan?

What is your budget?

• What are you able to pay each month in premiums?
• How comfortable are you covering co-pays or co-insurance for health services?
• What is your risk tolerance of high out-of-pocket costs?

Enrolling in a Medicare Plan

Annual Enrollment Period

Medicare's Annual Enrollment Period (AEP) occurs from October 15th to December 7th each year, providing an opportunity for you to evaluate your coverage and adjust if necessary. Whether you want to switch from Original Medicare to a Medicare Advantage plan or make a change within your existing Medicare Advantage options, AEP allows you to ensure that your health needs are met by your plan.

Initial Enrollment Period

The Initial Enrollment Period (IEP) is 7 months long. It includes your 65th birthday month plus the 3 months before and the 3 months after. It begins and ends 1 month earlier if your birthday is on the first of a month. For example – If you turn 65 on November 1, your Initial Enrollment Period is the same as those who have birthdays in October (except for on the 1st of October).

You may enroll in Original Medicare – Part A, Part B or both. You can also choose to join a Medicare Advantage plan (Part C) or a prescription drug plan (Part D).

You will receive your Medicare Benefits card approximately a few months before your 65th birthday. Have this card ready when you call or begin online enrollment. Below is an example of what your Medicare Benefits card would look like

General Enrollment Period

If you missed your Initial Enrollment Period, you could still sign up for a plan between January 1 - March 31 each year. This is called the General Enrollment Period. Your coverage would start July 1. If you enroll during this time, you might pay a monthly late enrollment penalty if you don't qualify for a Special Enrollment Period.

Medigap Open Enrollment Period

The Medigap Open Enrollment Period is 6 months long. It begins the month you are 65 or older and are enrolled in Medicare Part B. You cannot be denied coverage or charged more based on your health history if you enroll during the Open Enrollment Period. Some states may allow for additional Open Enrollment Periods.

Special Enrollment Period: Working past 65

There are certain situations when you can sign up for Part B (and Premium-Part A) during a Special Enrollment Period without paying a late enrollment penalty. A Special Enrollment Period is only available for a limited time. If you don't sign up during your Special Enrollment Period, you'll have to wait for the next General Enrollment Period, and you might have to pay a monthly late enrollment penalty.