Medicare Part A & Part B

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What's Covered?

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Medicare Advantage Plans are for some seniors who qualifies for Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) automatically and other people have to sign up for it. According to Medicare.gov, it depends on whether you’re getting Social Security benefits or not. 

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In general, what Medicare Part A covers:

• Inpatient care in a hospital

• Skilled nursing facility care   

• Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)

• Hospice care

• Home health care​

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Part B covers 2 types of services

• Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.

 

• Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

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You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.  

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Part B covers things like:

• Clinical research  

• Ambulance services

• Durable medical equipment (DME)

• Mental health

• Inpatient

• Outpatient

• Partial hospitalization

• Limited outpatient prescription drugs

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Medicare coverage is based on 3 main factors:

1. Federal and state laws.

2. National coverage decisions made by Medicare about whether something is covered.

3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.