What benefits and services can I get through Medicare?

Medicare covers services and supplies that are medically necessary to treat a disease or condition.[1593]

ORIGINAL MEDICARE (Part A and Part B): Part A covers hospital insurance,[1594] and Part B covers medical insurance.[1595] Part A Hospital Insurance covers: Hospital care; Nursing care; Nursing home care; Hospice; and Home health services.[1596] Part B Medical Insurance covers: Medically necessary services (services that are needed to diagnose or treat a medical condition); and Preventative services (heath care to detect or prevent illness).[1597]

You have your choice of doctors, hospitals, and other providers that accept Medicare. You pay a monthly premium for Part B, and you may pay no or very low premiums for Part A (depending on your employment history).[1598] Note: Part B is optional. When you enroll in Part A, you can choose whether to get Part B. If you’re on Social Security benefits, Part B premiums will get deducted from your Social Security checks; otherwise, you’ll get billed for Part B premiums.[1599]

MEDICARE ADVANTAGE PLAN (Part C): Part C plans include hospital and medical insurance (Parts A and B). Private insurance companies, approved by Medicare, provide this coverage. You choose a Part C plan, and then you must use doctors, hospitals or other providers listed in that plan (or else pay higher costs). You pay an extra premium for getting Part C, in addition to whatever it would cost you to be enrolled in Parts A and B (through Original Medicare).[1600]

MEDICARE PRESCRIPTION DRUG PLAN (Part D): Part D provides prescription drug insurance for anyone enrolled in Medicare. You choose a Part D plan, and it works as an addition to your Original Medicare (Parts A and B)—or your Medicare Advantage Plan (Part C). PLEASE NOTE: Part D is optional. When you enroll in Medicare, you can choose whether to get Part D. If you have low income, you can get extra help paying for Part D.[1601]

Below is a summary of eligibility for specific types of Medicare coverage.[1602]

MEDICARE PART (DESCRIPTION):

YOU’RE ELIGIBLE TO ENROLL IF:

Medicare Part A (hospital insurance): covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
You’re at least 64 years and 9 months old*; orYou have a qualifying disability; orYou have permanent kidney failure.Note: If you’re already getting Social Security benefits (see PG. 478), then when you turn 65 you’ll automatically get enrolled in Medicare Part A.
Medicare Part B (medical insurance): covers certain doctors’ services, outpatient care, medical supplies, and preventive services
You’re at least 64 years and 9 months old*; orYou have a qualifying disability; orYou have permanent kidney failure.Note: Part B is optional. When you first enroll in Part A, you can choose whether to enroll in Part B.
Medicare Part C (Medicare Advantage plans): are health plan offered by private companies that contract with Medicare to provide Part A and B benefits to you
You’re enrolled in both Part A and Part B; andYou don’t have permanent kidney failure.
Medicare Part D (prescription drug plan): adds prescription drug coverage to Part A, Part B, and some Part C plans. Part D plans are offered by private companies approved by Medicare.
You’re enrolled in Medicare.You’re not enrolled in a Part C plan that already includes prescription drug coverage.Note: Part D is optional. When you first enroll in Medicare, you can choose whether to enroll in Part D.
  1. 1593

    Some services may only be covered in certain places, or for patients with certain conditions. What Medicare Covers, Medicare.gov, http://www.medicare.gov/what-medicare-covers/. ↑

  2. 1594

    This includes hospital care, skilled nursing facility care, nursing home care, hospice care, and home health services. What Part A Covers, Medicare.gov, http://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html, Medicare Part A, Cal. Health Advocates http://www.cahealthadvocates.org/basics/partA.html ↑

  3. 1595

    Part B covers 2 types of services: medically necessary services that are needed to diagnose or treat a medical condition, and preventive services that help detect and prevent illnesses. This includes doctors’ visits, lab tests, ambulance services, mental health care, and certain medical supplies. Medicare Part B http://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html, http://www.cahealthadvocates.org/basics/partB.html. ↑

  4. 1596

    Medicare Part A, Medicare.gov, http://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html ↑

  5. 1597

    Medicare Part B, Medicare.gov ,http://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html. ↑

  6. 1598

    Part A costs vary based on how many years you (or your spouse) have paid into the Social Security system. If you have 10+ years of Social Security credit, you can get Part A without paying premiums. http://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/your-medicare-coverage-choices.html#collapse-3135.; Benefits Summary, Cal. Health Advocates, http://www.cahealthadvocates.org/basics/benefits-summary.html ↑

  7. 1599

    Medicare Part B, Cal. Health Advocates, http://www.cahealthadvocates.org/basics/partB.html. ↑

  8. 1600

    The details of MA plans available to you through Part C depend on where you live. Some cover prescription drugs; some don’t. http://www.cahealthadvocates.org/advantage/overview.html. ↑

  9. 1601

    Extra Help with Part D Costs for People with Low Income, Cal. Health Advocates,

    http://www.cahealthadvocates.org/drugs/extra-help.html. ↑

  10. 1602

    Medicare Eligibility: Who is Eligible for Medicare? Kaiser Permanente, https://medicare.kaiserpermanente.org/wps/portal/medicare/plans/learn/eligibility ↑