What’s Covered and Not Covered by Original Medicare

Written by: Vanessa Jerusalimiec (*Amsive Digital)  |  Reviewed by: Shelley Wyant  |  *MHP partners with Amsive Digital on news content

What’s Covered and Not Covered by Original Medicare

Original Medicare covers a range of health care services. This includes hospital care, medical care, and preventive care. But there’s a lot that Original Medicare does not cover. That’s why we offer Medicare Advantage plans to help you get the right health care coverage.

What is Original Medicare?

Original Medicare is a comprehensive health insurance program managed by the federal government. It’s available to adults 65 or older. Younger adults living with a disability or chronic health condition can also get Medicare coverage. Original Medicare is separated into two parts – Part A and Part B.

  • Medicare Part A is hospital insurance. It covers hospital stays and skilled nursing care.
  • Medicare Part B is medical insurance. It covers doctors’ services, preventive services, and medical supplies.

Many hospitals, doctors, and specialists around the country accept Medicare coverage, and you can access care anywhere in the US.

What Does Original Medicare Cover?

Medicare Part A and Part B cover hospital and medical services. Some services are completely covered, while others are partially covered. Even if a service is covered, you may have to pay a copayment or coinsurance when you access care.

Medicare Part A covers:

  • Inpatient care in a hospital setting
  • Skilled nursing facility care on a limited, short-term basis
  • Home health care on a part-time basis
  • Hospice and respite care

Medicare Part B covers:

  • Medical services such as doctor’s visits and specialist appointments 
  • Medically necessary services and supplies needed to treat a medical condition
  • A yearly wellness visit
  • Preventive services
  • Screening services
  • Vaccines like the annual flu shot
  • Durable medical equipment
  • Limited mental health support

To find out if a service or test is covered, you can visit Medicare’s Is my test, item, or service coveredtool. Type in your service, and get more detailed information about your coverage under Original Medicare.

What Is Not Covered by Original Medicare?

Original Medicare offers basic health care coverage, but it doesn’t cover everything. If you need any services not covered by Original Medicare, you’ll have to pay the full cost on your own. Some services not covered by Original Medicare include:

  • Prescription drug coverage
  • Dental coverage, like dental care and dentures
  • Vision coverage, like eye exams and prescription glasses
  • Hearing aids
  • Routine physical exams
  • Podiatry
  • Custodial care to help with the activities of daily living, such as bathing, eating, and dressing.
  • Massage therapy
  • Foreign travel emergency medical care

Does Original Medicare Cover Surgery?

Original Medicare covers some surgical procedures. For example, if you need surgery to treat an illness or diagnose a health condition, the surgery will be covered. These surgeries are called medically necessary surgeries. Medically necessary procedures can include heart surgery, transplant surgery, a knee or hip replacement, a mastectomy, hernia surgery, an appendectomy, and more. Original Medicare also covers anesthesia for surgeries.

You’ll need to work with your doctor or specialist to determine if the surgery meets Medicare’s coverage requirements. If your surgery is medically necessary, Original Medicare will cover 80% of the cost, and you’ll pay the remaining 20%.

What Surgical Procedures Are Not Covered by Original Medicare?

Original Medicare does not cover all surgeries. If your doctor determines that surgery isn’t medically necessary, then Medicare won’t cover the surgery. For example, cosmetic surgeries like a blepharoplasty or a rhinoplasty won’t be covered unless there is a medical reason you’re getting the surgery. Other surgeries that may not be covered by Original Medicare include laser eye surgery, bariatric surgery, removing a mole, and plastic surgery.

For most of these surgeries, you’ll pay the entire cost of surgery. Do you think your surgery is medically necessary? In some cases, Original Medicare covers a second opinion consultation to determine if your surgery is medically necessary.

Get More with MDwise Medicare

If you’re looking for a comprehensive health care plan in Indiana, MDwise Medicare has you covered. Our plans include all the same benefits as Original Medicare, plus added benefits. We offer vision, dental, and hearing coverage, prescription drug coverage, fitness membership allowance, transportation to medical appointments, and more. Contact us to get the comprehensive coverage you need.