Approximately 15 percent (44 million) of the population in the United States is enrolled in Medicare. Enrollment is expected to increase to 79 million by 2030. Many wonder what exactly Medicare covers. In this article, we will explore Medicare coverage.
You have the choice of two Medicare plans: Medicare (Part A and Part B) and the Medicare Advantage Plan (Part C). You can also purchase additional supplemental coverage such as Medicare drug coverage or Medigap (Medicare supplemental insurance).
13. Medicare Part A Coverage
With Medicare Part A, you will receive:
- Hospital inpatient care
- Nursing home care (this includes inpatient care at a skilled nursing facility)
- Home health care
- Hospice care
- Nursing facility care
12. Medicare Part B
Medicare Part B covers all services and supplies needed to successfully diagnose and possibly treat a medical condition. Also, certain preventative services are covered, such as an influenza vaccination or the ability to detect diseases during the early stages. With preventative services, there is no charge if you use a health care provider who accepts the insurance.
Part B coverage includes:
- Ambulance services
- Limited outpatient prescription drugs
- Mental health such as inpatient and outpatient, including partial hospitalization.
- Clinical research
- Durable medical equipment (DME)
11. The Medicare Health Plan
Medicare Health Plans are provided to private companies that contract with Medicare. They offer both Medicare Part A and Medicare Part B to individuals who enroll in the plan.
Medicare plans can include:
- Medicare Advantage Plans
- Demonstrations/Pilot Programs
- Medication Therapy Management (MTM), which covers complex needs for healthcare
- Programs for the elderly
- Pilot programs
10. Additional Medicare Part A Coverage Details
Hospital inpatient costs can quickly mount. However, certain things are covered under Medicare Part A, such as the following:
- Hospice care
- Blood transfusions
- Healthcare services
9. Things Not Covered by Medicare
Medicare might seem impressive, but it does not cover everything. Below are a few things that are not covered by Medicare.
8. Prescription Drugs
You’ll have to purchase a separate policy to cover prescription drugs. A Part D prescription drug policy (purchased separately) covers the expense of prescription pharmaceuticals. At the time you sign up for Medicare, you can choose to enroll in Medicare Advantage or Part D to cover your prescription expenses.
7. Long-Term Care
Sadly, long-term care is expensive for seniors. Many will end up in a nursing home, which costs up to $100,000 per year. Medicare does cover skilled nursing, but it does not cover custodial care.
6. Dental Care
Medicare does not offer coverage for routine dental care. Some Medicare Advantages do provide some care. However, it has an annual coverage cap that is usually set at $1,500. You can also purchase separate dental insurance policies to cover expenses or enroll in a dental discount plan to save money. Other options include saving money in a health savings account.
With a health savings account, you can use the money tax-free for any dental or medical expenses. However, please be aware that once you sign up for Medicare, you can no longer make any contributions to your HSA.
5. Vision Care
Medicare will cover an annual eye exam if you suffer from diabetes or if you must undergo cataract surgery. However, routine eye exams are not covered. You will need to purchase Medicare Advantage to obtain vision coverage or a supplemental policy which usually includes certain aspects of vision care.
Another option is the HSA savings plan such as was outlined under dental care. You can use the money from your HSA savings plan to pay for your vision needs.
4. Hearing Aids
The cost of hearing aids averages about $3,000 per ear, which is a sizable chunk of money that many seniors cannot afford. Some Medicare Advantage plans do cover fitting exams for hearing aids. You can also enroll in a discount program that provides low-cost hearing aids and accessories. Again, HSA can be used for hearing aid expenses just as it can for dental and vision.
3. Medicare Coverage When Traveling
Medicare does not cover your healthcare expenses when you travel outside the United States. However, there are clauses where Medicare will cover health care expenses, such as if you are on a cruise and you are within six hours of a U.S. port.
You can purchase Medigap Plans C and G, M, and N to cover up to 80 percent of care while you are abroad if you require emergency care. Depending on the situation, it can cover medical evacuation such as by a helicopter or plane.
2. Learning About Medicare Coverage
As with all medical insurance plans, you’ll want to learn what is and isn’t covered. Medicare is complicated, and you’ll want to explore the coverage rules to determine what is covered. Coverage for things such as care and procedures do vary.
To learn about Medicare coverage, visit Medicare.gov/coverage. There you will find a tool called “Is my test, item, or service covered?”. You can then learn about your Medicare coverage.
1. Appealing a Medicare Denial
If you make a claim and think that your Medicare plan should cover it, you will want to visit How to Appeal a Denied Medicare Claim to appeal the situation.