If you are nearing Medicare eligibility, it may be helpful to understand what Medicare does and does not cover before settling on a plan. There are some basic things that Medicare doesn’t cover, but many beneficiaries aren’t aware of those things before they choose to enroll in Medicare, so they go and seek services that aren’t actually provided under Medicare. To prevent beneficiaries from getting surprised medical bills for specific services, read the article and find out what Medicare coverage really is.
What does Original Medicare cover?
Original Medicare is made of two Parts- A and B. Part A is hospital insurance coverage and Part B is your medical insurance coverage. Therefore, traditional Medicare provides beneficiaries with the care you receive when you’re admitted to the hospital as an inpatient after an official doctor’s order, skilled nursing facility care, hospice care, home health care, and medically necessary services or health care used to prevent an illness or detect it at an early stage. Also, most non- self-administered medications will be covered under Part A and B.
However, if beneficiaries have Original Medicare only they will be responsible for cost-sharing through deductibles and co-insurance for most of the covered services because Medicare only covers 80% and beneficiaries need to pay for the rest of the cost. Additionally to that beneficiaries will not get coverage for:
- Vision services: you will not be covered for routine eye exams, glasses, or contact lenses but it covers medically necessary services like cataract surgery or glaucoma tests
- Hearing aids: it doesn’t cover routine hearing tests or hearing. aids but it does cover ear-related medically necessary services
- Dental services: don’t provide coverage for dental exams or dental work of any kind
- Routine physical examinations: Medicare doesn’t cover this Annual exam performed without relationship to treatment or diagnosis for specific illness or injury
- Nursing home care and long-term care: this can be confusing because Medicare does cover limited stay in a skilled nursing facility if is it medically necessary, for example ,you broke a leg and need inpatient care. But, if beneficiary just need help with the activities of daily living like dressing or bathing this is considered as long term care and is not covered under Medicare. This is also called custodial care.
How To Get Additional Coverage With Medicare?
If you have Original Medicare and want to get additional coverage for things that aren’t usually covered with Parts A and B you can do it by choosing Part C or Medicare Advantage plans as your primary source of coverage or with Medicare Supplement plans.
Medicare Advantage Plans
Medicare Advantage Plans, or Part C, must provide the same benefits offered by Original Medicare but it becomes your primary source of coverage instead of Original Medicare. However, Medicare Advantage can also offer additional benefits. If you’re concerned about not having coverage for the services Original Medicare does not cover, a Medicare Advantage Plan may be worth looking into. There are four main Medicare Advantage plans: High Maintenance Organization, Preferred Provider Organization, Private Fee For Service Plans, and Special Needs Plans.
Medicare Advantage plans often have this benefits included in their package:
Adult day-care services
Dental
Vision
Hearing
Fitness club memberships
Prescription drug coverage
Services and support for those with chronic conditions
Transportation to doctor visits
If you don’t want to purchase Medicare Advantage plans but instead keep Original Medicare and are worried about your prescription drug coverage you can purchase it through the Medicare Part D drug prescription stand-alone plan.
Medicare Supplement Plans
Medicare Supplements can only be used with Original Medicare to cover the gaps that are left by Original Medicare in for of deductibles, copayments, coinsurance, excess charges, and foreign travel emergencies. There are ten supplement plans you can choose and they are lettered from A to N. However, none of the Medicare Supplement Plans covers vision, dental services, or hearing aids. If you want to get this coverage but keep your Original Medicare you can do it by purchasing dental or vision insurance plans.
If you have any questions about your Medicare coverage options, give Temmen Insurance a call at 417-633-7200. We are eager to help you!