What Does Medicare Cover?

Part A

Also called hospital insurance, Medicare Part A covers the cost if you are admitted to a hospital, skilled nursing facility, or hospice. It also covers some home health services. Most people have enrolled automatically in Part A when they reach age 65.

With Part A, you’ll pay:

• A deductible each year. This is how much you have to spend before Medicare starts to pay its part.
• Coinsurance. This is the part of the costs for hospital care you may be required to pay after you’ve met your deductible. 

If you or your spouse receives Social Security benefits, you don’t have to pay a monthly fee to have Part A and will be automatically enrolled.

If you or your spouse doesn’t receive Social Security benefits, either because you are still working or because you don’t qualify, you will need to join through your local Social Security office. You will have to pay a monthly fee to have Part A if you are not eligible for Social Security benefits.

Part B

Also called medical insurance, Part B covers outpatient care. For instance, it pays for your visits to a doctor’s office, tests, and preventive care like cancer tests and vaccines.

Part B also covers some medical supplies, like blood sugar test strips, therapeutic shoes, and more. It’s common for people to be automatically enrolled in Part B, too.

For Medicare Part B, you pay:

• A monthly fee
• A deductible, which is a set amount you pay each year before Part B starts paying for any of your care
• Twenty percent of the Medicare-approved amount for some types of care. These are doctor’s appointments, physical therapy, diabetes supplies, durable medical equipment like commode chairs, wheelchairs, and other care. You have to meet your deductible first and then pay 20% of the services you receive.

If you see a doctor who has not agreed to accept Medicare-approved amounts, you will pay more — possibly up to the full cost — for a doctor’s visit and care.

This is how Medicare pays:

The way Medicare pays is, that you generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance/copayment) for covered services and supplies. There is no yearly limit for what you pay out-of-pocket. You usually pay a monthly premium for Part B. You generally don’t need to file Medicare claims. The law requires providers (like doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers to file your claims for the covered services and supplies you get.

Medicare pays for only a portion of your hospital and medical bills. As with many private insurance plans, the government expects beneficiaries to pay a share of their bills. Medicare Parts A and B both have deductibles and coinsurance. The deductibles for 2023 are $1,600 per Benefit Period, for Part A. 

A benefit period begins the day you are admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you have not received any inpatient hospital or SNF care for 60 days in a row. Therefore, it is possible to have multiple Part A hospital deductibles in the same year. In 2023 the Part B deductible is $226.00 per year. There are two types of private insurance available to cover all or part of these out-of-pocket costs. These insurance plans are called Medicare Advantage (the Part C of Medicare) or Medicare Supplements (also called Medigap or Medsup Plans).