Simple Truths: What does Medicare cover?

Posted on October 3, 2017

What does Medicare cover?

Original Medicare (Part A and Part B) does not cover everything. It provides basic coverage, but there will be gaps in the coverage. You should expect to be responsible for a portion of your health care costs, including deductibles and coinsurance. This is why many people enroll in additional coverage options that help pay for costs and benefits not covered by Original Medicare. These options include Part C – Medicare Advantage plans and Medigap – Medicare Supplement plans.

See chart below for a breakdown of coverage types and costs.

Original Medicare Costs Explained Further

Part A Deductible: If you only have Original Medicare (the red, white and blue card), you will have to pay your Part A deductible if you are admitted to a hospital or skilled nursing facility.

Solution: A Medicare Advantage or Medicare Supplement plan may cover this deductible.

Part B Deductible: If you only have Original Medicare, you will have to pay your Part B deductible when you use your Original Medicare card for outpatient services, such as doctors’ visits, labs, X-rays, etc.

Solution: A Medicare Advantage or Medicare Supplement plan may cover this deductible.

Part B Coinsurance and Copayments: If you only have Original Medicare, you will be responsible for 20% of the Medicare-approved amount of all medical bills after your Part B deductible is met.

Solution: Medicare Supplement plans typically pay for this cost. Medicare Advantage plans carry their own copayments, which can be less expensive than the 20% of the cost of a medical bill (i.e., $15 copay for a doctor visit vs. 20% of the total bill amount).

Premiums: Original Medicare charges a monthly Part B premium, which is calculated based on your adjusted gross income. It is important to know that, if you choose a Medicare Advantage or a Medicare Supplement plan, you must continue to pay your Medicare Part B premium in addition to the premium for the Medicare Advantage or Medicare Supplement plan.

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