What Benefit is Not Included in Medicare Part A

Understanding Original Medicare and Medicare Advantage

Understanding Medicare Part A and Part B

Medicare is a federal health insurance program designed primarily for people aged 65 and over, although younger individuals with disabilities or certain conditions may also be eligible for Medicare. Original Medicare consists of two parts: Medicare Part A and Medicare Part B. Each part covers different types of medical services.

What Medicare Part A Covers

Medicare Part A, also known as hospital insurance, is primarily responsible for covering inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. Here are some key benefits typically covered by Medicare Part A:

Inpatient hospital care
Skilled nursing facility care
Hospice care
Home health care

While Medicare Part A provides substantial coverage for these services, it is important to note that you must pay a deductible before Medicare will pay for services. Additionally, certain conditions must be met for services to be covered under Medicare Part A.

What is Not Covered by Medicare Part A

Despite its wide range of benefits, Medicare Part A does not cover everything. Some of the key services not covered by Medicare Part A include:

Long-term nursing home care
Most dental care
Eye exams related to prescribing glasses
Hearing aids and exams for fitting them
Custodial care in a skilled nursing facility

These services are not covered by Medicare Part A, and you may need to explore additional Medicare Plans, like Medicare Advantage or Medigap, to help pay for these costs.

The Role of Medicare Part B

Medicare Part B, or medical insurance, covers services and supplies that are medically necessary to treat your health condition. This includes outpatient care, preventive services, ambulance services, and durable medical equipment. Medicare Part B may cover some services not included in Original Medicare Part A, such as:

Doctor’s services
Outpatient care
Physical and occupational therapy
Some home health services

Part B coverage requires you to pay a monthly premium, and you may also have to meet a deductible before Medicare will cover your expenses.

Prescription Drug Coverage

Prescription drugs are generally not covered by Medicare Part A or Part B. For prescription drug coverage, you may need to enroll in Medicare Part D, which is a separate plan designed to help pay for prescription medications. This coverage is not included in Original Medicare, so it’s important to consider if you need this additional insurance coverage.

Are You Eligible for Medicare?

To be eligible for Medicare, you need to meet certain criteria. Generally, you need to be 65 years or older, a U.S. citizen or permanent resident, and eligible for Social Security or Railroad Retirement Board benefits. Younger individuals with specific disabilities or conditions may also qualify.