Original Medicare: What’s Covered and What Isn’t
Understanding the limits of Medicare can help you avoid costly surprises down the line.
Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). It’s the foundation of most people’s health coverage after 65 — often called Traditional Medicare — but it doesn’t pay for everything. Knowing what Medicare Part A covers, what Original Medicare covers, and what Traditional Medicare is helps you plan ahead and decide if you need additional protection, like a Medigap policy or a Medicare Advantage (MA) plan.
What Medicare DOES Cover
• Part A: Covers inpatient hospital stays, skilled nursing care after a qualifying hospital stay, hospice, and some home health care. Most people don’t pay a premium if they’ve paid Medicare taxes for 10+ years. This is the core of the question, “what does Medicare Part A cover?”
• Part B: Includes doctor visits, preventive services (like flu shots and mammograms), lab work, X-rays, durable medical equipment, mental health, and some home health. You’ll pay a monthly premium for Part B.
• Optional Part D prescription drug plan: Covers many generic and brand-name drugs, depending on the plan’s formulary. Purchased separately through a private insurer.
• Medicare Advantage (Part C, private alternative): These plans must cover everything in Parts A and B, often adding extras like vision, hearing, dental, and drug coverage. Networks and costs vary.
What Medicare DOESN’T Cover
• Long-term care: Custodial stays in a nursing home or assisted living aren’t covered. It’s one of the most common and expensive gaps in Original Medicare coverage.
• Most dental, vision, and hearing: Routine check-ups, glasses, and hearing aids aren’t covered unless tied to a medical procedure.
• Prescriptions (under Original Medicare): You’ll need a separate Part D plan or MA plan for drug coverage.
• Routine foot care and cosmetic procedures: Except when medically necessary, like diabetes-related foot exams.
• Overseas care: Medicare usually doesn’t pay for care outside the U.S., except in rare emergencies.
Why This Matters
If you’re asking, “What is Original Medicare?” or “What is Traditional Medicare?” Well, Traditional Medicare benefits offer a solid base, but major costs can still fall to you. If you rely on daily prescriptions, travel abroad, or want dental and vision included, it’s wise to explore add-ons. It also pays to learn how to sign up for Medicare Part A and B or how to apply for Medicare Part A only, depending on your needs and timing.
