Category: Medicare

Does Original Medicare Cover Everything?

Medicare: the well-known healthcare plan that you’re eligible for at 65. While you might know that it’s a type of health insurance, you might not be aware of what it covers — or doesn’t cover — when it comes to your healthcare needs.

At age 65 (and in special circumstances before 65), you can receive what is called Original Medicare coverage. It consists of Medicare Parts A (hospital insurance) and B (medical insurance). When you’re thinking of what Original Medicare might or might not cover, it’s like standard health insurance but without prescription drug coverage.

Part A helps cover costs of care when you’re in the hospital or a skilled nursing home as a follow-up to a hospital stay. It can also help with the cost of home healthcare and hospice care. Part B helps cover costs from doctor or other health provider visits. It covers medically necessary services and supplies as well as preventive services such as flu shots and annual wellness exams. Part B also covers basic health screenings like mammograms and prostate exams.

 Original Medicare does NOT cover:

  • Prescription drugs (exception: select medications that are administered by a doctor)
  • Dental (including dentures)
  • Eye exams for glasses or contacts
  • Hearing aids and fitting exams
  • Long-term care (i.e. help with basic activities like bathing, dressing, etc.)
  • Routine foot care
  • Care outside the U.S. (anywhere other than the 50 U.S. states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands) except in very limited situations
  • Many other services, treatments or procedures such as acupuncture and cosmetic surgery

Keep in mind that Original Medicare is not free. While you don’t have to pay a premium for Medicare Part A if you or your spouse paid Social Security taxes through your job for at least 10 years, Part B does come with a monthly premium of $135.50. Parts A and B also come with their own deductibles: $1,364 and $185 respectively. This means that for each type of service (hospital or medical), you’ll pay the full rate until you meet the corresponding deductible. After that, you will be responsible for 20 percent of the costs you acquire.

Another important thing to note is that there are limits to how much help you can receive, and that is based on the number of days you spend in a hospital or skilled nursing facility. You can spend up to 60 days in the hospital with a $0 co-insurance. After that, your co-insurance rises drastically, and, eventually, if you stay long enough (more than 150 days), you’ll be responsible for all your costs. A similar situation is true for stays at a skilled nursing facility except you’ll only get 20 days with $0 co-insurance. After day 100, you will pay all your acquired costs.

You should also know that there is no maximum out-of-pocket protection (MOOP) with Original Medicare. This means there is no limit to the amount of money you might have to pay out of your own pocket each year. So, while you’ll receive help paying your healthcare costs, those costs can stack up to an amount that could far surpass what you’re capable of paying.

Without added coverage and protection, an unexpected illness or injury could put your savings at risk. That’s why most people, after signing up for Parts A and B, get extra coverage. For more information on your Medicare coverage options, visit our Medicare Learning Center and check out 3 Most Common Medicare Questions and What Are My Medicare Coverage Options.

For more information on Medicare or what each part of Medicare covers, visit our blog and check out “Do You Understand the Basics of Medicare?” and “The ABCs and Ds of Medicare: What Does Each Part of Medicare Cover?”

Essence Healthcare