What Benefits Are Covered by Medicare?

Medicare is a government program that offers health insurance coverage for people 65 and older and others with certain disabilities. The available benefits will depend on the type of Medicare plan you choose.

It's important to understand your Medicare benefit options, so you can select the plan or plans that best suit your needs.

Medicare Part A is the hospital insurance portion of Original Medicare, but its benefits extend beyond what you might expect for this type of coverage. Medicare Part A benefits include:

• Hospital stays: Hospital stays at acute care hospitals, critical access hospitals, inpatient rehab facilities, inpatient psychiatric facilities and long-term care hospitals are covered under Medicare Part A.

• Skilled nursing facility care: Medicare Part A covers limited stays in Medicare-approved skilled nursing facilities if you've had a hospitalization that qualifies — and if you still have available days left in your benefit period. Some covered services may include a semiprivate room, meals, medications, skilled nursing care, and medical supplies and equipment.

• Hospice care: Medicare Part A covers hospice care as long as your doctor certifies that your condition is terminal and you're not expected to live longer than six months. Some hospice care benefits include doctor, nursing and medical services; pain management drugs; medical supplies; and short-term inpatient care to manage pain and other symptoms.

Medicare Part B is the medical insurance portion of Original Medicare. It covers two basic types of services:

Preventive services

Preventive services are designed to prevent or screen for illness. Some Medicare benefits included in Part B-covered preventive services are:

• Bone density screening.

• Cervical cancer screening.

• Flu, hepatitis, COVID-19 and pneumococcal vaccines.

• Mammograms.

• Cardiovascular disease screenings.

• Certain cancer screenings.

• Annual wellness visits.

Medically necessary services

These Medicare benefits include services and supplies used to diagnose or treat a medical condition. For example, when you visit a participating doctor or other health care provider, have a minor outpatient procedure like cataract surgery or receive Medicare-approved durable medical equipment such as wheelchairs or scooters, this care is covered by Medicare Part B. Medically necessary services may also include:

• Ambulance services.

• Mental health services, including outpatient care, inpatient care and partial hospitalization.

• Some limited outpatient prescription medications.

Covered by Medicare Part A and Part B: Home health care

Some limited home health care is covered under Medicare in certain circumstances — and this benefit may be covered under Medicare Part A and/or Part B. These Medicare benefits, which a home health care agency typically coordinates, may include:

• Intermittent or part-time skilled nursing care or home health aide.

• Physical and occupational therapy.

• Speech-language pathology.

• Durable medical equipment and medical supplies.

• Medical social services.

• Injectable osteoporosis drugs.

Medicare Advantage, also known as Medicare Part C, is private health insurance offered by government-approved insurance companies. These plans provide a bundled alternative to Original Medicare, including hospital coverage (Part A), medical coverage (Part B) and usually Medicare Part D prescription drug coverage.

Medicare Advantage must provide at least as much coverage as Original Medicare, so all services covered under Medicare Part A and Part B are also covered under Medicare Advantage plans. However, the specific rules, participating provider networks, copays, coinsurance and other details may vary from plan to plan and insurer to insurer.

Many Medicare Advantage plans also offer some coverage for additional benefits not included with Original Medicare, such as:

• Annual physical exams.

• Acupuncture.

• Dental care.

• Vision care.

• Hearing.

• Personal medical alert systems.

• Gym memberships.

Medicare Part D is prescription drug coverage designed to complement Medicare Part A and Part B plans, neither of which include prescription drug coverage.

Since Medicare Part D is offered by private insurance companies, which drugs are covered and at what cost may vary, depending on the insurer and specific plan. However, all Part D plans are required to cover a wide range of prescription drugs commonly used by people on Medicare, including many drugs that fall into protected classes such as cancer medications.

Before choosing a Part D plan, compare and check out each policy's formulary (list of covered medications) to ensure it meets your health needs. It's also wise to compare premiums, coverage levels, deductibles, copays and other plan specifics to select your best option.

Medicare Supplement Insurance, or Medigap, is health insurance sold by private insurance companies to reduce your out-of-pocket health care expenses. It closes the "gaps" in Original Medicare coverage by paying for certain copayments, coinsurance, deductibles and services that Medicare Parts A and B don't cover. Once Original Medicare plans pay their share, Medigap policies kick in to pay the leftover covered expenses.

There are 10 different types of Medigap plans currently operating in most states. Premiums and certain perks may vary, but the benefits of each Medigap plan type are otherwise standardized.

To be eligible for Medigap, you need to be enrolled in Medicare Part A and Part B. (Medigap isn't compatible with Medicare Advantage.)