What Does Medicare Cover?

brian86964
Nov 1, 2024
3 min read

Updated: Oct 16

Navigating Medicare can be daunting, especially when trying to understand what services and treatments are covered. For residents of Texas, it’s essential to know the specifics of Medicare coverage to make informed healthcare decisions.

This article breaks down the key components of Medicare and what it covers.

Understanding Medicare

Medicare is a federal health insurance program primarily designed for individuals aged 65 and older, although younger individuals with disabilities or specific medical conditions may also qualify. The program consists of four main parts: Part A, Part B, Part C (Medicare Advantage), and Part D.

Medicare Part A: Hospital Insurance

Medicare Part A covers inpatient hospital stays, skilled nursing facilities, hospice care, and some home health services. Key aspects of Part A coverage include:

Inpatient Hospital Stays: Part A covers room and board in a hospital, along with necessary hospital services and supplies.
Skilled Nursing Facility Care: If you require skilled nursing care after a hospital stay, Part A can cover your stay in a skilled nursing facility (SNF) for a limited time, provided certain conditions are met.
Hospice Care: Medicare covers hospice services for those diagnosed with terminal illnesses, focusing on comfort and quality of life rather than curative treatment.
Home Health Services: Part A may cover limited home health care services, such as skilled nursing and therapy services, when ordered by a doctor.

Medicare Part B: Medical Insurance

Part B covers outpatient care, preventive services, and some home health care. Key features of Part B coverage include:

Doctor Visits: Medicare Part B covers visits to your primary care physician and specialists, including necessary medical exams and consultations.
Preventive Services: This includes vaccinations, annual wellness visits, screenings for various conditions (like cancer and diabetes), and cardiovascular disease screenings.
Outpatient Care: Part B covers outpatient hospital services, such as emergency room visits and outpatient surgeries.
Durable Medical Equipment (DME): Medicare may cover equipment like wheelchairs, walkers, and oxygen therapy devices that are deemed medically necessary.

Medicare Part C: Medicare Advantage

Medicare Advantage plans, or Part C, are private insurance plans that combine coverage from both Part A and Part B and often include additional benefits. Many plans in Waco offer extra coverage, such as:

Vision and Dental Coverage: Many Medicare Advantage plans include routine vision exams, eyeglasses, and dental services, which are not typically covered under Original Medicare.
Prescription Drug Coverage: Most Medicare Advantage plans include Part D coverage, allowing you to get your medications through the same plan.

Medicare Part D: Prescription Drug Coverage

Part D provides prescription drug coverage to help Medicare beneficiaries manage their medication costs. Each Part D plan has its own formulary, or list of covered drugs, so it’s essential to review available plans in Waco to find one that meets your medication needs.

Final Thoughts

Understanding what Medicare covers is crucial for residents of Texas, as it helps you make informed choices about your healthcare. Whether you are nearing age 65 or seeking coverage options due to a disability, knowing your Medicare benefits can save you time and money.

If you need assistance navigating your Medicare options, consider reaching out to Bright Sun Health & Medicare. Our experienced team is dedicated to helping you understand your coverage options and finding the best plans tailored to your needs.