What are Medicare's basics?

Medicare originally covered people ages 65 and over. Later, the program expanded to include people with permanent disabilities or the severe kidney disease ESRD, or end-stage renal disease. To be eligible for Medicare, the expanded population must meet certain requirements set out by the Social Security Administration.

Medicare provides partial coverage for certain medical services. (It does not cover dental work, cosmetic surgery, health care services obtained in another country, hearing tests, long-term care, routine eye care, eyeglasses, most shots or long-term care.) The main coverage has two parts, A and B.

Medicare Part A: Covers hospital stays. People eligible for Medicare can usually get Part A coverage without paying a monthly premium, because they've already paid into the system via Social Security withholdings.

Part A coverage includes meals, supplies, necessary testing and a semi-private room. Private rooms aren't covered unless medically necessary. Rehabilitation and other skilled nursing services are covered. Medically necessary home health care is covered, but only on a part-time, intermittent basis. Certain medical equipment, including walkers, wheelchairs and other supplies, also are covered. Part A also covers hospice care for the terminally ill, including drugs and support services for pain relief and treatment of symptoms.

Medicare Part B: Insurance that covers medically necessary doctor's appointments. A monthly premium is required, and patients must meet an annual deductible before coverage kicks in.

Part B insurance covers outpatient medical and surgical services, diagnostic tests and some medical equipment. It also offers home health care coverage. Other than a one-time "Welcome to Medicare" exam, It doesn't cover routine checkups.

Parts A and B are collectively known as Original Medicare. It allows a patient to visit any doctor that accepts Medicare, but coverage is somewhat limited. The coverage exceptions and Part B's deductibles and co-payments are "gaps" in Medicare. Private companies provide "MediGap" insurance policies to cover those gaps.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.