What does my original Medicare cover and not cover?

Original Medicare is a federal health insurance program consisting of two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). Together, they provide essential coverage for various healthcare services.

Part A: Hospital Insurance

Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care. It generally covers:

• Inpatient hospital stays: Including meals, semi-private rooms, general nursing, and other hospital services and supplies.

• Skilled nursing facility care: After a qualifying hospital stay, for services like physical therapy and rehabilitation.

• Hospice care: For terminally ill patients, focusing on comfort and quality of life.

• Some home health care: Limited to specific services like part-time skilled nursing care and therapy.

Most people don't pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working. However, there may be deductibles and coinsurance costs associated with these services.

Part B: Medical Insurance

Part B helps cover outpatient care, preventive services, and some home health care. It generally covers:

• Doctor's services: Including visits to specialists and general practitioners.Medicare

• Outpatient hospital services: Such as outpatient surgery, lab tests, and certain screenings.

• Durable medical equipment (DME): Like wheelchairs, walkers, and oxygen equipment.

• Preventive services: Including flu shots, cancer screenings, and annual wellness visits.

• Mental health services: Outpatient counseling and therapy.

Part B requires a monthly premium, which is $185 in 2025, though this amount may vary based on income. Additionally, there is an annual deductible of $257, after which you typically pay 20% of the Medicare-approved amount for most services.

What Original Medicare Doesn't Cover

While Original Medicare provides comprehensive coverage, it doesn't cover everything. Notably, it doesn't cover:

• Routine dental care: Including cleanings, fillings, and dentures.

• Routine eye exams and glasses: Except in certain circumstances.

• Hearing aids and related exams: For fitting and maintenance.

• Long-term care: Such as custodial care in a nursing home.

• Cosmetic surgery: Procedures not deemed medically necessary.

• Most prescription drugs: Unless they are administered in a hospital outpatient setting.

To cover these additional services, you might consider enrolling in a Medicare Advantage Plan (Part C) or purchasing a Medicare Supplement Insurance (Medigap) policy