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What Does Medicare Cover?

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What does Medicare cover under Original Medicare?

Original Medicare, Part A and Part B, is the basic government-sponsored health insurance program for Americans aged 65 and over and those at any age who qualify by disability. You also qualify under the age of 65 if you have Lou Gehrig’s disease or end-stage renal disease. You must be either a U.S. citizen or legal permanent resident of at least five continuous years. Medicare Part A is hospital insurance, and Medicare Part B is medical insurance.

In general, Medicare covers many medical services and supplies, often requiring you to pay a deductible, copayment, or coinsurance depending on the service. You need to use Medicare-assigned health-care providers at Medicare-enrolled facilities to be covered, in most cases.

Original Medicare doesn’t cover prescription medications in most situations. Medicare Part A may cover prescription drugs you receive as a hospital inpatient, while Medicare Part B may cover certain prescription drugs you receive in an outpatient setting. For most of your medications that you typically take at home, you would need to enroll in Medicare prescription drug coverage; you can do that either through a Medicare Advantage Prescription Drug plan or a stand-alone Medicare Prescription Drug Plan.

Read more details about what Medicare Part A and Medicare Part B cover.

What does Medicare cover under Medicare Advantage (Medicare Part C)?

Medicare Part C, otherwise known as Medicare Advantage, offers an alternative way to receive your Original Medicare coverage. Medicare Advantage plans, offered by private, Medicare-approved insurance companies, cover everything Original Medicare covers (except hospice care, which Medicare Part A covers). These plans often include extra benefits, such as routine dental or vision services and prescription drug coverage. Some Medicare Advantage plans may require you to use doctors and other providers within the plan network. When you’re enrolled in a Medicare Advantage plan, you’re still in the Medicare program, and you continue paying your monthly Medicare Part B premium, along with any premium the Medicare Advantage plan may charge.

What does Medicare cover under Part D Prescription Drug Plans?

Stand-alone Medicare Part D Prescription Drug Plans are also available from private insurance companies that contract with Medicare. These plans work alongside Original Medicare to help with prescription drug costs. Each Medicare Prescription Drug Plan has a list of drugs it covers, called a formulary. Different plans may have different formularies, and the formulary may change at any time. You will receive notice from your plan when necessary.

Do you have questions about what the different “parts” of Medicare cover? Feel free to contact one of eHealth’s licensed insurance agents – you’ll find contact information below.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.


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