When joining Medicare, it’s incredibly common to be unsure of what exactly Medicare covers. We frequently get asked what exactly does everything cover, and many people are surprised when they find medical bills in the mail.
Whether you choose Original Medicare or Medicare Advantage, they must both cover the same essential services as determined by Medicare Part A and Medicare Part B.
Here is what you might not know. Even if Medicare covers these essential services, they rarely, if ever, cover 100 percent of the cost of the service.
At a high-level Medicare covers the following services:
Medicare Part A – Hospital Insurance (This coverage varies from service to service)
- Inpatient care in hospitals
- Skilled nursing facility care (only if it’s medically necessary)
- Hospice
- Home-health (only if it’s medically necessary)
Medicare Part B – Medical Insurance (80 percent coverage, after deductible)
- Basic doctor visits
- Many preventative services
- Outpatient Care
Medicare Part D – Prescription Drug Coverage (Must have Medicare Part A and Medicare Part B to qualify)
Helps cover the cost to Medicare-approved drug once the deductible has been met.
Services Medicare DOES cover:
Therapy
While Medicare has always covered physical, occupational, and speech therapy, in the past, they only covered up to a certain dollar amount.
However, Medicare raised the cap on therapy, and now they will pay for much more treatment. This is important, especially for people with illnesses such as Parkinson’s, who need extensive treatment.
Chemotherapy
Most people don’t know this, but Medicare Part B covers chemotherapy. Since health care professionals must administer chemotherapy, this care is covered under Medicare Part B, not your prescription plan.
Preventative Services
Some preventative services are part of the Affordable Care Act. You pay nothing for most of these services if you are in line with the rules.
Some of these services include:
- Bone mass measurement
- Various types of cancer screenings
- Cardiovascular disease screenings
- Diabetes screening (you may be eligible for up to 2 diabetes screenings each year)
- Glaucoma tests
- Flu Shots
- Obesity screening and counseling
- Yearly “Wellness” visit
Services Medicare DOES NOT cover include:
Chiropractic care
Medicare covers manipulation of the spine if medically necessary to correct your spine if a bone moves out of position. However, you will be responsible for the costs of other services or tests ordered by a chiropractor (including X-rays and massage therapy).
Too frequent cancer screenings
For example, Medicare covers one clinical breast exam every 24 months. If you are at high risk for cervical or vaginal cancer, Medicare covers these screening tests once every 12 months. Tip: most doctors forget this rule, so when they order you an exam at each of your annual visits, you will be responsible for paying for the additional exams.
Vision, Dental and Hearing
Medicare covers medically necessary vision, dental, and hearing services. However, it doesn’t cover non-medically necessary vision, dental, and hearing services. Not medically necessary services include annual exams, eyeglasses, dental fillings, and hearing aids.
You can get coverage for these services through some Medicare Advantage plans or separate vision, dental or hearing insurance plans.
Services at certain health care providers
While Medicare does cover medically necessary services, you may not be able to get treatment from certain doctors of certain health care providers.
For example, we often see people who are signed up for Medicare Advantage plans wanting to get treatment from facilities like M.D. Anderson if they are diagnosed with cancer. This is an issue because while M.D. Anderson currently accepts Original Medicare, it doesn’t accept most Medicare Advantage plans. Many Medicare beneficiaries are shocked to find out they can’t get treatment from certain doctors like this when they face a serious health issue.
Long-Term Care
Medicare will not cover most long-term care services. Medicare will only cover care if it’s medically necessary, but they will not cover care if its only for custodial purposes.
For example, if you have Parkinson’s and need the care to bathe and feed you, Medicare will not cover that service.
To get a full list of services Medicare does and doesn’t cover, please look at Medicare’s “Medicare & You” handbook.
Medicare is extremely complicated. It’s critical to your health and financial future that you understand what Medicare does and doesn’t cover. Understanding this ensures that you make your Medicare decision based on what is best for you and your unique situation.
To easily make your right Medicare decision, join our Medicare Enrollment Concierge today by CLICKING HERE.
