What Does Medicare Cover?

About Medicare Coverage

Medicare has four parts and depending on the plan you select, Medicare coverage can include:

  • Medicare Part A, which covers most inpatient services at hospitals and skilled nursing facilities.
  • Medicare Part B, which covers most outpatient services such as doctor’s visits, preventive services, and lab work.
  • Medicare Advantage (Part C), which covers all of Medicare Parts A and B plus benefits like dental, vision, hearing, and more.

  • Medicare Part D or Prescription Drug Plan (PDP), which covers most of the costs associated with prescription drugs.

What Does Original Medicare (Parts A and B) Cover?


Original Medicare has two parts: Medicare Part A coverage and Medicare Part B coverage.

  • Medicare Part A covers most inpatient services at hospitals and skilled nursing facilities. This includes coverage for a semi-private room, hospital meals, drugs, and medical supplies and equipment used during an inpatient stay. Part A also covers lab tests, x-rays, operating room and recovery room services, and some blood transfusions. Skilled nursing services are covered, including care in special units such as intensive care, inpatient or outpatient rehabilitation services after a qualified inpatient stay, and some part-time home health services after a qualified inpatient stay. Think of it as your inpatient care coverage for unexpected injury or illness.

  • Medicare Part B covers most outpatient care such as doctors’ visits, annual wellness visits, and scheduled preventive services like flu shots or mammograms. Part B coverage also includes clinical laboratory services, like blood and urine tests, x-rays, MRIs, CT scans, EKGs, and some other diagnostic tests.




What Is Not Covered By Medicare Parts A & B, Or Original Medicare?


Many people need more coverage than Original Medicare provides. Here are a few examples of things that Medicare Part A and Part B do not cover:

  • Most prescription drugs

  • Long-term care or nursing home care
  • Inpatient hospital care beyond certain limits

  • Medical care outside the U.S.
  • Custodial care that helps with daily life activities like eating and bathing

  • Most dental care including dentures
  • Eye exams (for prescription glasses)

  • Hearing aids and exams for fitting them
  • Personal expenses while receiving inpatient care
  • Cosmetic and elective surgery (unless for a medical purpose)
  • Routine physical exams
  • Gym memberships
  • Concierge care (also known as concierge medicine or retainer-based medicine)
  • Covered items or services you receive from an opt-out doctor or other provider (except in cases of an emergency or urgent need)




What Is Part C Or Medicare Advantage Plan Coverage?


Medicare Parts A and B do not cover 100% of your healthcare costs. Medicare Advantage plans are another option for filling in the gaps in your coverage.


Medicare Advantage plans give you added coverage and act as comprehensive all-in-one plans. They may include Medicare Part A and Part B plus additional benefits like:


  • Dental care including cleanings, X-rays, and dentures

  • Vision care including contacts and glasses
  • Hearing care including hearing aids and regular testing

  • Other benefits including online fitness classes and an allowance for over-the-counter healthcare items




What Is Part D Prescription Drug Coverage?


Part D Medicare insurance covers prescription medications. If prescription drugs are part of your ongoing healthcare, then you may want to add a Part D plan to your Original Medicare coverage. Or you can choose a Medicare Advantage plan that includes prescription drug coverage.




What Else Does Medicare Cover?


Pre-existing Conditions


If you have Original Medicare (Parts A and B) coverage or a Medicare Advantage (Part C) plan, you are generally covered for all Medicare benefits even if you have a pre-existing condition.


Elective Procedures


Medicare covers many expenses related to essential surgical procedures, but it does not cover elective surgeries (such as cosmetic surgeries) unless they serve a medical purpose.


Medical Devices


Medicare will cover some medical devices if they are deemed medically necessary. Medicare will only cover your durable medical equipment if your doctors and equipment suppliers are enrolled in Medicare.


Home Healthcare


Medicare pays for you to get healthcare services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury.




Not Sure About Medicare Coverage For Certain Healthcare Needs?


Talk to your doctor. If it’s not clear whether your treatment, medication, or any other procedure is covered, just ask. Compare Medicare coverage with Anthem to find a plan that fits your changing health needs.




When Are You Eligible For Medicare Coverage?


You’re eligible for Medicare when you turn 65. Around the time of your 65th birthday, there’s a seven-month window called the Initial Enrollment Period (IEP), when you can apply for Medicare:


  • Three months before the month you turn 65

  • The month you turn 65

  • Three months after the month you turn 65


If you miss your IEP, you have another chance to enroll. You can sign up for Medicare Part A and Part B between January 1 and March 31 each year. Your Medicare coverage begins on the first of the following month.




Can You Change Your Medicare Coverage Once You’ve Enrolled?


If you find you need more coverage or want a different plan after you’ve enrolled in Medicare, you can apply for a new plan during the Annual Enrollment Period — also known as the Annual Election Period. This window, from October 15 to December 7 each year, allows you to add, drop, or change your coverage. You also have a chance to change your existing Medicare Advantage plan from January 1 to March 31 during the Medicare Advantage Open Enrollment Period. The most important thing is to find the Medicare coverage that works for you.




Find a Medicare Plan That Fits Your Needs

Other Articles From "Understanding Medicare and Its Parts"

Anthem Blue Cross is a Medicare Advantage plan with a Medicare contract. Anthem Blue Cross is a D-SNP plan with a Medicare contract and a contract with the state Medicaid program. Enrollment in Anthem Blue Cross depends on contract renewal.