What Medicare Does and Does Not Cover

When enrolling in Medicare, it’s best to know what can and cannot be covered. This is the next thing to consider once you have attained eligibility. 

Each person has different needs, and because of this, Medicare is split into four distinct parts (A, B, C, and D) to meet those specific needs. Parts A and B are the Original Medicare plan. Part C is Medicare Advantage. Part D refers to medication coverage.

If you choose to enroll in Medicare, you can do so by visiting ssa.gov. You may also join by visiting a Social Security office near you, or by calling Social Security at 1-800-772-1213. 

Medicare Part A

Part A covers inpatient care. This includes:

• Hospital stays
• Emergency room visits
• Care in skilled nursing facilities
• Meals while receiving inpatient treatment
• Medications administered to you while you are receiving inpatient treatment

Medicare Part B

Part B covers outpatient care. This includes:

• Preventive services
• Physical therapy
• Equipment such as wheelchairs, defibrillators, blood glucose monitors
• Ambulance transportation

Part B also covers 80% of your Medicare-approved costs following your annual deductible payment.

Medicare Advantage

Medicare Advantage Covers:

• Services covered by Original Medicare (Medicare Parts A and B)
• Additional services like eye exams and gym memberships
• Prescription drugs
• Medicare costs following payment of Medicare Advantage’s annual deductible

Medicare Part D

Medicare Part D is the prescription drug plan. The extent of the coverage depends on the specific plan you choose that is available in your area. In general, these plans are required to cover at least two medications per drug category.

Part D covers these types of medications: 

• Antidepressants
• Antipsychotics
• Anticonvulsants
• Anti-cancer
• Immunosuppressants
• HIV/AIDS medications

If you have Medicare Advantage, you may have access to additional prescription drug benefits not covered by the standard Medicare Plan D.

What Medicare Doesn’t Cover

Medicare does not cover cosmetic procedures. Also, Medicare coverage applies to healthcare treatment in the U.S. – not other countries. It doesn’t cover anything for someone who does not meet the requirements for enrolling. As far as medications go, benzodiazepines, barbiturates, hair growth, virility, and prescription weight loss medications are not covered.

If you have any questions

At Sannes Insurance, we are dedicated to your needs. We are here to assist you with any questions you may have regarding Medicare and the various aspects of it. Give us a call at (509) 993-9887 today.