Medicare Insurance Parts A and B

Medicare covers services (like lab tests, surgeries and doctor visits) and supplies (like wheelchairs and walkers) considered medically necessary to treat a disease or condition.

If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you at least the same coverage as Original Medicare. Some services may be covered only in certain settings or for patients with certain conditions.

In general, Part A covers:

• Hospital care
• Skilled nursing facility care
• Nursing home care (as long as custodial care isn’t the only care you need)
• Hospice
• Home health services

Part B covers two types of services:

• Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
• Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.*

*An agreement by your doctor, provider or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.

Part B also covers things like:

• Clinical research
• Ambulance services
• Durable medical equipment (DME)
• Mental health
• Inpatient services
• Outpatient services
• Partial hospitalization
• Getting a second opinion before surgery
• Limited outpatient prescription drugs