What Benefit is Not Included in Medicare Part A?

November 13, 2024•3 min read

Understanding your Medicare coverage is crucial, especially when planning for healthcare expenses. While Medicare Part A offers some essential benefits, it's important to know what it doesn’t cover. This knowledge helps you make informed decisions about your health plan and anticipate potential out-of-pocket costs.

Understanding Medicare Coverage

Medicare is a federal health insurance program primarily for people aged 65 and older, though certain younger individuals with disabilities or specific conditions can also qualify. The program consists of various parts, each covering different services:

Part A: Hospital Insurance
Part B: Medical Insurance
Part C: Medicare Advantage Plans
Part D: Prescription Drug Coverage

Original Medicare includes Part A and Part B. While it provides substantial health coverage, it doesn’t cover every medical service you might need. That's why understanding what each part covers—and doesn’t cover—is key to managing your healthcare costs effectively.

What Does Medicare Part A Cover?

Medicare Part A helps pay for inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care. Here's a closer look at what Part A covers:

Inpatient Hospital Stays: Covers semi-private room, meals, general nursing, and other hospital services.
Skilled Nursing Facility Care: Covers skilled nursing services, rehabilitation, and other related services after a qualifying hospital stay.
Home Health Care: Covers medically necessary part-time skilled nursing care, physical therapy, and more.
Hospice Care: Covers pain relief, medical and support services for terminally ill patients.

While these services are beneficial, it's essential to know what Medicare Part A may not cover.

Services Not Covered by Medicare Part A

Despite its comprehensive nature, Medicare Part A doesn’t cover several important services. Some of these services are:

Long-term Care: Medicare doesn’t cover long-term care, also known as custodial care, if that’s the only care you need.
Routine Dental and Vision Care: Services like dental checkups, cleanings, or eyeglasses are not covered.
Hearing Aids: Medicare doesn’t cover hearing aids or exams for fitting them.
Routine Foot Care: Ordinary foot care services are not covered unless medically necessary due to underlying conditions.
Cosmetic Surgery: Procedures intended to improve appearance without medical necessity are not covered.

Understanding these gaps in coverage can help you decide if additional insurance is necessary to meet your healthcare needs.

How Medicare Part B Helps Cover What Part A Doesn’t

Medicare Part B covers certain doctor services, outpatient care, medical supplies, and preventive services. Here’s how Part B coverage can complement what Part A doesn’t cover:

Doctor Visits: Covers visits to your doctor, including consultations and preventive services.
Outpatient Care: Includes outpatient hospital services and treatments.
Durable Medical Equipment: Helps pay for medical equipment like wheelchairs and walkers.
Preventive Services: Covers screenings, shots, and yearly wellness visits to prevent illness.

Medicare Part B can help bridge the gap for services that Medicare Part A doesn’t cover, but like Part A, it’s not comprehensive.

Additional Benefits and Considerations

While Original Medicare (Parts A and B) provide essential health coverage, you might consider additional Medicare Plans for more comprehensive benefits:

Medicare Advantage Plans (Part C): Plans may offer additional benefits like dental, vision, or hearing.
Medicare Supplement Insurance (Medigap): Helps cover costs not paid by Original Medicare, like copayments, coinsurance, and deductibles.
Prescription Drug Coverage (Part D): Covers prescription drugs that Original Medicare doesn’t.