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What Medicare Covers (Parts A and B)

When Medicare was created in 1965, it was never intended to fully pay for the medical expenses it covers. In fact, Medicare generally pays only 80% of covered medical services.

Here's how it works

Medicare is offered in two parts, Part A and Part B.

Part A

Most people receive Part A automatically when they turn 65. If you or your spouse worked at least 40 quarters and paid Medicare taxes during that time, you will not have to pay a premium to get Part A. If you are not eligible for premium-free Part A, you may be able to buy it if:

• You didn't work;
• You didn't pay enough Medicare taxes; or
• You are disabled and have returned to work.

Part B

Part B is voluntary. You must first have Part A, then agree to pay a monthly fee (a premium) if you want Part B coverage.

Medicare Part A Covers Hospital and Other Medical Facility Costs

Part A helps cover inpatient facility care - in most cases you pay either a deductible or a copay, based on your length of stay. Medicare pays the balance. Part A helps pay for the following:

• General inpatient hospital costs
• Rehabilitation costs
• Skilled nursing facility care
• Hospice care
• Inpatient mental health stays

Medicare Part B Covers Doctor Visits and Other Medical Services

Part B requires a premium and helps cover doctor visits and other medical services not covered by Part A. In most cases, it pays 80% of these costs:

• Doctors' services (except routine physical exams)
• Ambulance services
• Outpatient services and supplies
• Diagnostic tests
• Ambulatory surgery center fees for approved procedures
• Durable Medical Equipment (DME)
• Prosthetics
• Second surgical opinions
• Outpatient physical therapy, occupational therapy and speech therapy
• Outpatient mental health care
• Clinical laboratory services
• Home care - under certain conditions
• Some preventive screening services