Deciding what Medicare coverage you need can be confusing, most people opt for Original Medicare (Part A and Part B) as this will cover the basic and most necessary healthcare needs for most individuals. This article will examine what is covered by Part A and Part B. Medicare coverage is dependent upon a number of factors, including state and federal laws, national decisions made by Medicare as to what is covered, and on a local level individual companies who deal with Medicare claimants will make decisions based on what they deem to be medically necessary.

Part A – Hospital Insurance

Part A of Medicare will generally cover:

  • Care in a hospital (including in-patient and long term hospital stays)
  • Skilled facility care (including physical and occupational therapy)
  • Nursing home care (however custodial care isn’t covered if there are no other treatments required)
  • Hospice and respite care (often at home but this is dependent on treatment and type of terminal illness)
  • Home health services (like occasional skilled nursing care, occupational therapy, and speech therapy)

Part B of Medicare will generally cover:

  • Medically necessary services – Treatments, services and supplies that meet accepted standards of medical practice that are necessary to diagnose and treat any condition or symptoms you begin to experience.
  • Preventive services – Treatments that can prevent illness (like the flu jab) or for detection of an illness in the initial stages.
  • Part B will also cover –
    • ambulance transportation
    • clinical research
    • inpatient, outpatient or partial hospitalised mental health care and treatment
    • Durable Medical Equipment (DME)
    • Being able to request a second opinion before any surgical procedure

In most instances, it is best to check with the health care provider why certain treatments or services are required, and ask if they will be covered by Medicare. If there is any doubt as to whether a particular treatment or service is required, there may be a fee which will require payment.