What Does Your Medicare Cover

what does your medicare cover

Between the different plans and parts and programs, trying to shop for insurance can be a headache. Your money is valuable, and you want to make sure you are allocating it towards coverage that is right for you.

That is why we have decided to create the holy-grail blog of all Medicare parts, policies, and programs out there. Keep in mind, Medicare Supplement parts are standardized, unlike Medicare Advantage plans. Also, remember that costs, no matter the plan, are not standardized. They will vary depending on that in which you reside. Click here to learn more about the difference between a Medicare Supplement (Medigap) and Medicare Advantage plans.

Part A- Original Medicare consists of two parts: Part A and Part B. Part A is your hospital insurance. This will cover inpatient hospital care, a skilled nursing facility visit, lab tests, surgery, and home health care.

Part B- This second half of Original Medicare is your medical insurance. Services from your doctor and other health care providers, outpatient care, durable medical equipment, home health care, and some preventive services are all covered by Part B.

Note, at this point, your Original Medicare does not cover any long-term care, most dental care, routine eye exams, dentures, cosmetic surgery, acupuncture, hearing aids and their exams to fit them, or routine foot care. From this point, you may purchase other plans as additions to your Original Medicare to assure all your needs are covered.

Part D- This is one of two ways to get prescription drug coverage. Part D plans are often called “PDPs.” Part D is coverage you can purchase as an addition to your Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. The rules of these plans can vary, so it is important you discuss the coverage with your provider.

The following Medicare Supplement plans are standardized but will differ if you live in Massachusetts, Minnesota, or Wisconsin.  Medicare Supplement Plans are designed to assist you in your Original Medicare out-of-pocket costs.

Plan C- This policy will provide both additional coverages for both inpatient and outpatient care. It does cover the same benefits as Part A and Part B. Some benefits include doctor visits, ambulance services in an emergency, mental health services, preventative tests and vaccines (including flu shots), physical therapy, occupational therapy, and speech and language pathology. Plan C may cover some extra benefits such as routine appointments; however, it is often in the event of an accident or disease. Additional benefits would result in a higher monthly premium.

Plan F- In 2020, Plan F is speculated to get discontinued. However, you may still want to know the plan may cover inpatient hospital costs, coinsurance, deductibles for Parts A and B, limited emergency medical care overseas, hospice care coinsurance/copayments, first three pints of blood, and Part B excess charges.

Plan G- Plan G is very similar to Part F. It will cover everything Plan F covers except for the Medicare Part B excess charges.

Plan K- This plan and its benefits pay 50 percent of cost-sharing expensive in your Original Medicare including your Part A deductible, Part A hospice care, and Part B copayment and coinsurance, first three pints of blood for a covered medical procedure, and skilled nursing facility care coinsurance.

Plan L- Plan L varies in the cost coverage. For example, Plan L covers 100 percent of your Medicare coinsurance and hospital costs up to one year after Original Medicare benefits are exhausted. It will also cover 75 percent of your Medicare Part A hospice and Part B coinsurance or copayment, Part A deductible, first three pints of blood, and skilled nursing facility care coinsurance costs.

Plan M- Plan M is the same as Plan D except that Plan M requires you to pay half of the Medicare Part A deductible.

Plan N- This plan will cover 100 percent of the Part B coinsurance costs. The only exception is that you are required copayments at office and emergency room visits. Office visits have a $20 co-pay, and emergency room visits can have up to a $50 co-pay. Plan N does not cover your Part B deductible or excess charges.

Call your local Avery Hall expert if you would like to learn more about Medicare or your coverage!

What Your Medicare Does and Does Not Cover (Version 2)

Between the different plans and parts and programs, trying to shop for insurance can be a headache. Your money is valuable, and you want to make sure you allocate it towards coverage that is right for you.

That is why we have decided to create the holy-grail blog of all Medicare parts, policies, and programs out there. Keep in mind, Medicare Supplement parts are standardized, unlike Medicare Advantage plans. Also, remember that costs, no matter which plan, are not standardized. They will vary depending on that in which you reside. Click here to learn more about the difference between a Medicare Supplement (Medigap) and Medicare Advantage plans.

Part A- Original Medicare is consists of two parts: Part A and Part B. Part A is your hospital insurance. This will cover inpatient hospital care, a skilled nursing facility visit, lab tests, surgery, and home health care.

Part B- This second half of Original Medicare is your medical insurance. Services from your doctor and other health care providers, outpatient care, durable medical equipment, home health care, and some preventive services are all covered by Part B.

Note, at this point, your Original Medicare does not cover any long-term care, most dental care, routine eye exams, dentures, cosmetic surgery, acupuncture, hearing aids and their exams to fit them, or routine foot care. From this point, you may purchase other plans as additions to your Original Medicare to assure all your needs are covered.

Part D- This is one of two ways to get prescription drug coverage. Part D plans are often called “PDPs.” Part D is coverage you can purchase as an addition to your Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. The rules of these plans can vary, so it is important you discuss the coverage with your provider.

The following Medicare Supplement (Medigap) plans are standardized but will differ if you live in Massachusetts, Minnesota, or Wisconsin.  Medicare Supplement Plans are designed to assist you in your Original Medicare out-of-pocket costs.

  • Plan C
  • Plan F
  • Plan G
  • Plan K
  • Plan L
  • Plan M
  • Plan N

Call an Avery Hall expert if you have more questions about Medicare or your coverage!


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