Real Senior Management
What Does Medicare Cover
There are four parts of Medicare, each providing different coverage for seniors depending on their health and medical needs. Most beneficiaries choose Part A and B as their basic coverage plan. In contrast, others prefer to get more coverage by considering other parts of Medicare.
Here’s what these plans entail:
• Part A Inpatient/Hospital coverage
• Part B – Outpatient/Medical Coverage
• Part C – Part A and Part B coverage with additional services
• Part D – Prescription drug coverage
As an insurance agent, it’s very important that you learn the coverage involved with these plans so you can be the best resource to your clients. People work with those who educate them, so being that top resource of information means you’re doing your job correctly and making sure your clients are getting all the help and information they need.
As an individual looking for coverage, you need to know what each part of Medicare provides so you can make an informed decision on your healthcare. That’s why working with an experienced agent, such as those with Real Senior Management, will help you learn this important information and guide you in the right direction.
Now, let’s go into more depth with what each part covers.
Medicare Part A
When discussing Part A with your clients, you’ll have to explain the following services:
• Inpatient/ Hospital Care: Includes the care you receive while you are admitted to the hospital. Up to 90 days of your hospital care expenses, 60 lifetime reserve days, and up to 190 lifetime days in a Medicare-certified hospital are covered by the plan.
• (SNF) Skilled Nursing Facility care: Covers board, room, and other services provided in SNF. Coverage is provided for up to 100 days of each benefit period (terms and conditions applied).
• Hospice Care: If approved by a provider, anyone can have this coverage when terminally ill. It can be used for as long as the provider recommends.
• Home Health Care: For homebound individuals who need skilled care. Individuals are covered for an unlimited amount of intermittent care or up to 100 days for daily home care.
Medicare Part B
Part B of Medicare benefits the individual by cutting down the out-of-pocket expenses by providing Outpatient/Medical coverage. Here is a summary of services covered under Part B:
• Provider Services: Necessary services you receive from a licensed health practitioner.
• (DME) Durable Medical Equipment: Equipment like walkers, oxygen tanks, and wheelchairs can be purchased or rented from a Medicare-approved supplier after the provider approves it.
• Ambulance Services: Emergency transportation facility from and to hospitals. However, non-emergency service is limited to some extent.
• Home Health Services: Home care services for homebound people who need skilled care.
• Preventive Services: Screenings, consultations, counseling, etc., to prevent potential illnesses, to detect health conditions, and to keep you healthy.
• Therapy Services: Outpatient speech, physical, occupational therapy services by a Medicare-certified therapist.
• Other Services: Mental health services, X-rays, lab tests, chiropractic care, selected prescription drugs.
Medicare Part C
Medicare Part C is commonly known as Medicare Advantage. Part C lets you have all the benefits covered in Part A and Part B, with additional services that may include:
• Dental care
• Vision care
• Hearing care
• Prescription drug coverage
• Adult daycare
• Gym memberships
• Nutrition programs
• Wellness programs
• Transportation (for doctor visits)
However, all MA plans have different costs, restrictions, and rules, which affect the way you receive care. They also have various networks of providers, which can restrict where you receive your care.
Medicare Part D
Part D provides coverage for prescription drugs. The plan is exclusively offered through private companies, whether as a standalone plan for those with Original Medicare or as an additional benefit with an MA (Part C) plan.
Each Part D plan has a formulary (a list of covered drugs), but you need to ensure with your provider that your Part D plan covers the prescriptions you need. All Part D plans must provide coverage for most, if not all of the drugs in these categories:
• All vaccines except the ones covered by Part B
• Anticancer
• HIV/AIDS
• Antipsychotic
• Antidepressants
• Anticonvulsive
• Immunosuppressants
What Medicare doesn’t cover?
Medicare plans cover a wide range of benefits, but not everything. In short, Medicare doesn’t cover services like:
• Most dental care services
• Eye exams
• Hearing aids
• Acupuncture
• Cosmetic surgeries
