It is important to understand the coverage that Original Medicare offers. By understanding this, Medicare beneficiaries can make more informed decisions about other types of insurance that they choose to enroll in.
Original Medicare Coverage
- A semi-private room
- Operating room
- Post-op recovery room
- Care in special units
- Hospital meals
- Lab tests
- Medications and equipment
- Rehabilitation services while and inpatient
- Blood transfusions
- Skilled nursing care
What is not included in Medicare coverage?
Medicare Age Requirements
Medicare Advantage Coverage
Medicare Advantage (Part C) plans are Medicare-approved plans provided by private companies that offer an alternative to Original Medicare for your health and drug coverage. These plans include Part A, Part B, and usually Part D. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services. Medicare Advantage Plans have yearly contracts with Medicare and must follow Medicare’s coverage rules. Also, each Medicare Advantage Plan can charge different out-of-pocket cost, and can also have different rules for how you get services.
Part D Coverage
Medicare Part D, also known as the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D, like Medicare Advantage, is offered through private companies either as a:
- stand-alone plan, for those enrolled in Original Medicare, or
- as a set of benefits included with your Medicare Advantage Plan
Medicare Part D has a list of prescription medications it covers. This list is also known as the formulary which contains all the prescription drugs Part D offers coverage for. If a drug you need is not on the Part D formulary, you may have to request an exception, pay out of pocket for drug expenses, or file an appeal which you can use to ask your plan provider to reconsider the decision about the drug in question.