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Understand What Original Medicare Does and Doesn’t Cover Before the Medicare Annual Enrollment Period

Understanding your healthcare coverage is the first step toward ensuring you have a Medicare plan that’s a great fit for you. Staying informed is especially important before the Medicare Annual Enrollment Period, which is one of your biggest opportunities to change Medicare plans.

Original Medicare

Original Medicare is the healthcare coverage offered through the federal Medicare program administered by the Centers for Medicare and Medicaid Services (CMS). It’s available to most U.S. citizens age 65 and older, as well as those under 65 with disabilities. Original Medicare is made up of Part A and Part B, which provide different categories of coverage.

What Original Medicare Covers

Part A
Medicare Part A covers hospital and facility care, including:

  • Inpatient care in a hospital
  • Skilled nursing facility care
  • Inpatient care in a skilled nursing facility (not custodial or long-term care)
  • Hospice care
  • Home health care

Part B
Preventative and medically necessary services and supplies are covered under Medicare Part B. Services and supplies that may be covered include:

  • Medical Equipment
    • Diabetes supplies
    • Mobility equipment—walker, wheelchair, cane, etc.
    • Hospital bed
  • Ambulance transportation, when necessary
  • Mental health treatment
  • Mammograms
  • Flu shot
  • Yearly check-up

This is an incomplete list of covered services, used only for example. Many more services and supplies may be covered, if they’re deemed “medically necessary.”

What Original Medicare Doesn’t Cover

A number of healthcare services aren’t covered under Original Medicare, including:

Healthcare in these categories can be critical to your wellbeing. In fact, you could be subject to fees for not obtaining prescription drug coverage, even though it’s outside Original Medicare’s coverage.

How to Receive Additional Coverage

Medicare plans beyond Original Medicare are offered by private insurance companies that are contracted with the federal government. You can enroll in these plans during the Medicare Annual Enrollment Period.

Medicare Part D
Medicare Part D Plans offer only prescription drug coverage and can be enrolled in on top of your Medicare Parts A and B coverage.

Medicare Part C
Part C Plans, or Medicare Advantage Plans, are private plans that include the coverage offered by Original Medicare and may include additional benefits, such as vision, dental, hearing, fitness, wellness, and prescription drug coverage. Some of these plans may be available in your area with $0 premiums, deductibles, and copays, so you may have the opportunity to gain additional benefits at no additional cost.

Get Help During the Medicare Annual Enrollment Period

We can help you find Medicare plans in your area, evaluate those plans for the coverage and costs that matter to you, and enroll you in the plan of your choice. The Medicare Annual Enrollment Period is the time when many people enroll in Medicare Advantage Plans or change their plans, since it’s an open enrollment period for all Medicare beneficiaries.

You may be eligible to enroll in a Medicare plan during other Medicare Special Enrollment Periods. Our Medicare Advocates can assist you in determining your enrollment eligibility.

For your no-cost personal consultation with a Medicare Advocate, call 1-800-991-4407 / TTY 711 from 10 a.m. to 9 p.m. Eastern, Monday to Friday.