What do Medicare Parts A and B cover?
Medicare Parts A and B are called Original Medicare. Together, they cover a range of important health care services.
Medicare Part A coverage offers hospital insurance. This may include inpatient care coverage for:
- Hospitals and skilled nursing facilities
- Hospice care
- Home health care
Medicare Part B coverage offers insurance for care that is medically necessary and some preventive care. This may include things like medical screenings, durable medical equipment and ambulance services.
What do Medicare Parts A and B not cover?
Original Medicare covers a wide range of care, but it can’t cover everything. Medicare Part A does not provide coverage for hospital stays related to cosmetic surgery that isn’t medically necessary. It also doesn’t cover room and board and other services for long-term stays in nursing homes or assisted living facilities.
Medicare Part B may cover some preventive care, but it doesn’t cover things like dental, vision and hearing.
What does Medicare Part C cover?
Medicare Part C coverage (also called Medicare Advantage) offers everything you get with Parts A and B, but often with added benefits. Aetna® Medicare Advantage plans offer coverage that Original Medicare doesn’t. For example, you can find plans with dental, vision and hearing coverage, and prescription drug coverage. This coverage is added on top of the medical, preventive and hospital coverage Parts A and B offer.
The things Part C does not cover vary by plan. For example, one plan might cover eye exams, while another might not. Make sure you consider your health care needs before joining a plan.
Explore Aetna Medicare Advantage plans to find added benefits and find the coverage you need.
What does Medicare Part D cover?
Part D is a main source of Medicare prescription drug coverage. Medicare Part D covers drugs that are not covered by Original Medicare. It’s often included as part of a Medicare Advantage plan. Getting Part D coverage as soon as you can help to avoid late enrollment penalties.
Some drugs are not covered by Part D. Here are some of the most common that are not covered:
- Erectile dysfunction drugs
- Over-the-counter drugs (OTC)
- Cosmetic drugs like hair loss medication (some skin care drugs may be covered)
Be sure to consider your prescription drug needs carefully before joining a Part D plan.
Enroll in an Aetna Medicare Part D plan.
Does Medicare cover hospice?
You may be able to get Medicare benefits for hospice care through Part A. This coverage includes the care you need, but doesn’t include:
- Treatment meant to cure your condition
- Prescription drugs meant to cure your condition
- Room and board
- Inpatient or outpatient hospital care and ambulance rides
To qualify for hospice care coverage, you must meet these conditions:
- Your doctor certifies that you are terminally ill with a life expectancy of six months or less.
- You accept care to make you more comfortable rather than cure you.
- You sign a statement choosing hospice care over other Medicare-covered treatments.
Wondering how long Medicare covers hospice care? You get two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.
Does Medicare cover nursing homes and long-term care facilities?
You can get a limited amount of Medicare nursing home coverage if you need further treatment after a hospital stay. This coverage only lasts for short-term stays and does not include custodial care (nonmedical care). You must meet the following conditions to get coverage:
- You have Medicare Part A with days left in your benefit period.
- You first have an inpatient hospital stay of at least three days in a row.
- You begin your stay at the skilled nursing facility within 30 days of leaving the hospital.
- Your health care provider has decided you need daily skilled medical care.
- You are getting care at a Medicare-certified skilled nursing facility.
In long-term care situations, Part A will not cover most services. But it may cover your drug costs if you are getting skilled nursing care. Aetna Medicare offers plans that can give you more long-term care coverage.
Learn more about Aetna Medicare Institutional Special Needs Plan if you need more coverage for long-term care.
Does Medicare cover home health?
Medicare home health care may be available if you qualify. Here are some covered home care services:
- Skilled nursing care (must be medically necessary)
- Physical therapy, occupational therapy and speech-language pathology services
- Medical social services
- Durable medical equipment
- Nonmedical support like bathing and feeding (if you’re already getting skilled nursing care or a therapy service)
To qualify for home health care with Medicare:
- You must have difficulty leaving your home because of illness or injury.
- A health care provider must recommend that you do not leave home because of your condition.
- A health care provider must order skilled medical care for you from a Medicare-certified home care agency.
- You must get a home health care plan from this home care agency. It should include things like the care you need, what healthcare professionals will provide it and how often you will need care.
Do you need care at a specialized facility? Aetna Medicare offers plans that may make staying in one of these places more affordable. Compare Aetna Medicare Institutional Special Needs Plans (I-SNPs).
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Does Medicare cover medical devices?
You may be able to get durable medical equipment with Medicare Part B. This may include Medicare coverage for wheelchairs, lift chairs and many other kinds of medical devices and mobility aids.To get this coverage, your doctor must prescribe the equipment for use in your home. Your doctor and the supplier of the equipment must also be enrolled in Medicare.
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Does Medicare cover eye exams?
With Original Medicare, eye exams are not covered in most cases. But there are some exceptions:- Diabetic eye exams
- Glaucoma testing (for those with high risk)
- Macular degeneration testing
In all other cases, you can only get vision coverage from a Medicare Advantage plan.
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Does Medicare cover chiropractic care?
Medicare and chiropractic care don’t always go together, but there are times when you can get coverage. Medicare Part B covers manual manipulation of the spine to aid spinal joint motion. Other chiropractic services like massage therapy and X-rays are not covered. You may be able to get coverage for other services with a Medicare Advantage plan.
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Does Medicare cover a colonoscopy?
You can get Medicare colonoscopy coverage through Part B as preventive care. If you are at high risk of colorectal cancer, Medicare will cover a screening colonoscopy every 24 months. If you are at lower risk, you can get one every 48 or 120 months.
Does Medicare cover preexisting conditions?
Original Medicare will cover your preexisting conditions as soon as you’re enrolled. The same is true for Medicare Advantage plans. They can’t deny you coverage because of preexisting conditions.
Medicare Supplement Insurance plans (Medigap) also cover them. These plans help cover out-of-pocket costs for Original Medicare. But there are some exceptions to when they cover preexisting conditions. Medigap may not cover preexisting conditions for the first six months you have your plan. After those six months, you will be covered. It also may not cover your condition if it was diagnosed or treated six months before your Medigap coverage started.
Do you have a chronic condition? Sign up for an Aetna Medicare Chronic Condition Special Needs Plan (C-SNP) to get more of the support you need.
Disclaimer
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