What does Medicare Cover?

Medicare is a federal health insurance program for people ages 65 and older and those with certain disabilities. Find out what’s covered and not covered in Medicare Parts A, B, C and D.

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Whether you are just making the transition to Medicare, or you are assisting a loved one seeking additional coverage, you may be wondering what does Medicare cover, what isn't covered, and how does it all work?

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How Medicare works

Check out this infographic for an overview of the parts of Medicare. Additional detail about Medicare Parts A and B is below.

The ABCDs of Medicare Infographic

The ABCDs of Medicare:

Part A (Original Medicare (CMS*)) includes partial coverage for inpatient hospital stay, skilled nursing care, hospice and home care.

Part B (Original Medicare (CMS*)) includes partial coverage for doctor visits, surgery, lab tests, medical equipment and preventive exams.

Part C, or private insurers and health plans, is similar to Parts A and B with predictable out-of-pocket costs and more coverage. Part C often fully covers wellness services, vision exams and hearing exams. Part C often partially covers eye glasses and hearing aids.

Part D, or private insurers and health plans, helps with the cost of prescription drugs not covered by Original Medicare. Part D covers some prescription drugs.

*Centers for Medicare and Medicaid Services

 

Medicare Part A helps pay for inpatient care. It is offered at no cost to nearly everyone eligible for Medicare. The cost is usually covered by taxes you've paid throughout your working life. Part A benefits include:

  • Hospitalization in a semi-private hospital room, meals and other eligible services
  • Skilled nursing care after a hospital stay
  • Home health care visits ordered by a doctor, delivered by a Medicare-certified agency
  • Hospice care, including drugs to relieve pain

Medicare Part B helps pay for outpatient professional services and tests. Part B is available for a monthly premium. Part B benefits include:

  • Doctor's services in the hospital, clinic, doctor's office or home
  • Diagnostic tests, such as x-rays and lab tests
  • Medical supplies for diabetes testing, surgical recovery and durable medical equipment
  • Outpatient services for rehabilitation, diagnostic, treatment and surgery

What is not covered by Original Medicare?

Medicare Parts A and B do not cover all expenses. You are responsible for the following:

  • Paying your Part B premium (amount set by the federal government each year)
  • Deductibles, copays and coinsurance
  • Outpatient prescription drugs
  • Vision and hearing services

How can I fill the gaps in Medicare coverage?

You may choose to enroll in a Medicare supplemental plan, which offers coverage for health care or prescription drugs that Medicare does not cover. Examples of these types of plans are Medicare supplement (Medigap), Medicare Cost, Medicare Advantage, and Medicare Part D prescription drug plans.

Blue Cross and Blue Shield of Minnesota offers these Medicare plans:

  • Blue Cross Medicare Advantage (PPO) and (HMO-POS) – Our newest Medicare plans may be available where you live. These plans offer you the convenience of one plan, one card and one bill with combined medical and prescription drug coverage. Find out if the plan is available to you.
  • Senior Gold(SM) (Medicare supplement) – A plan that lets you build the most comprehensive health coverage available from Blue Cross.
  • Platinum Blue(SM) with Rx (Cost) – A Medicare-approved Cost plan may be available where you live. Choose from three options, and you can add prescription drug coverage for convenience and simplicity. Find out if this plan is available to you.
  • MedicareBlue(SM) Rx (PDP) – A stand-alone prescription drug plan with a Medicare contract that helps cover the costs of prescription drugs and can be paired with a medical-only plan.

More about how Medicare works

What will my Medicare expenses be?
Medicare well care visits
Medicare eligibility and age requirements
Get help understanding Medicare at a workshop
Review Medicare plan options
Learn about Medicare supplemental plans

 

Blue Cross offers PPO and HMO-POS plans with Medicare contracts. Enrollment in these Blue Cross plans depends on contract renewal.
Last updated September 30, 2018
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