Medicare & Long-Term Care Learn About Medicare

This is the part of Original Medicare that primarily covers inpatient hospital care and gives you access to:

1. acute or critical access hospitals
2. inpatient rehabilitation facilities
3. inpatient psychiatric facilities
4. long-term care hospitals

Medicare Part A does NOT cover:

1. private-duty nursing
2. long-term or custodial care in a nursing home
3. concierge care
4. private hospital room (unless medically necessary)
5. television or phone in hospital room (additional cost)
6. cosmetic surgery
7. most dental care or dentures

Part A pays for hospital stays, skilled nursing care, and some outpatient home healthcare services.

This is the part of Original Medicare that primarily covers medically necessary services and specific preventive care, including:

1. services from doctors and other healthcare providers
2. outpatient care
3. X-rays and lab tests
4. ambulance services
5. some home healthcare
6. durable medical equipment such as insulin pump, wheelchair, walker, hospital bed, and other equipment
7. preventive services such as counseling, vaccines, and screenings for cancer, diabetes and other illnesses
8. yearly wellness visits
9. clinical research
10. care for mental health and substance use disorders (counseling, therapy, and inpatient/outpatient care)
11. oxygen equipment and accessories

Medicare Part B does NOT cover:

1. long-term or custodial care
2. cosmetic surgery
3. most dental care, including cleanings or dentures
4. eyeglasses or contact lenses for routine vision
5. hearing aids/exams for fitting
6. prescription drugs
7. routine foot care
8. medical services outside the U.S. (in most cases)

This part is another term for a Medicare Advantage plan. These are all-inclusive plans offered by private health insurance companies approved by Medicare.

Unlike Original Medicare, you get everything you need in one plan, so all your care is coordinated. There’s no juggling multiple plans and multiple companies.

Medicare Advantage (Part C) plans include:

1. all the coverage of Medicare Part A
2. all the coverage of Medicare Part B
3. Part D prescription drug coverage (for Medicare Advantage Prescription Drug Plans (MAPDs))
4. additional benefits not included in Original Medicare can include vision, hearing, and dental benefits, an OTC card, and more

By law, Medicare Advantage plans must include all services offered by Original Medicare. The additional benefits they offer vary by plan.

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This part is another term for Medicare prescription drug coverage. It can be offered as a standalone plan or part of a Medicare Advantage Prescription Drug plan offered by private health insurance companies to help pay for prescription drugs.

Part D plans cover the cost of outpatient prescription drugs, including brand-name and generic medications.

All prescription drug plans have a formulary—a list of prescription drugs covered by your health plan. Covered drugs are grouped into tiers, which may affect your costs. In general, most brand-name drugs will be more expensive than generics.

If you have a Medicare Advantage plan that includes prescription drug coverage, you’ll be covered so you don’t need to enroll in a separate Part D plan.

If you qualify for Medicare, you can get Original Medicare, which includes Part A and Part B.

You’ll need prescription drug coverage as well, so you can add on a Part D prescription drug plan.

Or you can get a Medicare Advantage plan (also called Part C), which combines Part A, Part B, and (in most cases) Part D, all in one convenient plan.

These all-inclusive Medicare Advantage plans provide extra benefits not offered by Original Medicare, such as:

1. an OTC card
2. the SilverSneakers^® fitness program
3. coverage for hearing, vision, and dental