Understanding Medicare Benefits: What’s Included?

Posted on April 15, 2021

When it comes to Medicare coverage, it can be confusing to figure out what is included. Each part of Medicare covers different aspects of care and provides its own specific benefits. 

At The Pavilion Senior Living, we provide care and services at senior living communities throughout Tennessee and West Virginia. We understand that trying to figure out what is and is not covered by your plan can be a frustrating process. When you need care, you want to know what is covered by Medicare and what you will be expected to cover without having to guess.

To help you better understand your Medicare benefits, we are sharing what is included in each part of Medicare, as well as what the program does not cover.

What is Medicare?

eHealth Medicare states that “Medicare is a government-sponsored health insurance program for American citizens and permanent legal residents (of at least five years in a row) who are 65 years old or more, or who qualify by disability or certain conditions.”

While the term “Medicare” covers the whole program, the program is broken down further into parts that cover different areas of care:

  • Part A – also known as “hospital insurance”
  • Part B – commonly referred to as “medical insurance”
  • Part C – often called the “Medicare Advantage”
  • Part D – also named “prescription drug coverage”

Enrolling in Medicare

Let’s say your 65th birthday is coming up, and you are already receiving Social Security or Railroad Retirement Benefits. In that instance, you will automatically be enrolled into Medicare Part A and Part B on the first day of the month in which you turn 65.

If, however, you are not already receiving retirement benefits as your 65th birthday approaches, you do have the option to manually enroll in Medicare during your Initial Enrollment Period. This period refers to “the seven-month period that starts three months before you turn 65, includes your birthday month, and ends three months later.”

What happens if you did not want Medicare benefits during your Initial Enrollment Period, but you do now? Is it too late to enroll? Absolutely not. eHealth Medicare states, “if you missed your Initial Enrollment Period, you can also sign up for Medicare Part A and Part B during the General Enrollment Period that takes place from January 1 to March 31 every year.”

What is Included in the Medicare Benefits?

Medicare Part A

Medicare Part A helps to cover the costs of hospital expenses. These Medicare benefits include room and board in a hospital, inpatient hospital services, ambulance services, home health care and hospice, or a short stay in a skilled nursing care community like The Pavilion Senior Living in Tennessee or West Virginia.

Medicare Part B

Also referred to as the “medical insurance” part of Medicare, Part B helps cover expenses such as doctor and physician visits and services, outpatient services, medical and lab services, and medical equipment and supplies. Additionally, Medicare Part B may also help cover some of the costs of occupational and physical therapy services.

Medicare Part C

According to Humana, “known as Medicare Advantage, Medicare Part C plans cover all of your Medicare Parts A and B benefits plus they may also include Medicare Part D prescription drug coverage.” By choosing to enroll in a Medicare Part C plan, you have the convenience of receiving your Medicare benefits in one all-inclusive plan.

Medicare Part D

Medicare Part D is simply for covering the costs of prescription drugs. Even if you are enrolled in other parts of Medicare, you still may need to supplement your Medicare Part D coverage to help you pay for your prescription medications.

What Medicare Does Not Cover

  • Long-term care services such as assisted senior living
  • Most dental care – while some Medicare Part C plans do include dental care, there is often a coverage cap
  • Routine vision care
  • Hearing health or hearing aids
  • Medical care outside of the United States

There are many Medicare benefits and plan options to choose from. Because not every plan covers all care and services, it is important for you to carefully consider your needs and weigh your options, keeping in mind that you may need to purchase supplemental coverage separately.

To learn more about what is included in the care and services we provide in our communities, contact a member of our senior living team in Tennessee or West Virginia or visit The Pavilion Senior Living website.