Learn what Medicare does—and doesn’t—cover and how you can fill in the gaps of service.
Medicare provides health insurance coverage to Americans age 65 and older and those with certain disabilities or end stage renal disease (ESRD). The program consists of different parts: A, B (together these are generally referred to as “Original Medicare”), C and D. Medicare doesn’t cover everything, however; learn what it does and doesn’t cover.
What Medicare covers
Most Medicare services require you to pay a deductible, coinsurance or copayment. Here’s a brief look at each part of the program, and what it covers.
- Part A provides hospital insurance and covers inpatient stays, care in a skilled nursing facility, hospice care and some home health care.
- Part B provides medical insurance for certain services performed by doctors, outpatient care, certain medical supplies and preventive services.
- Part C, also referred to as Medicare Advantage, is offered by private insurers who contract with Medicare to provide the coverage of both Parts A and B. These plans must cover everything Medicare covers, but often differ in how costs are paid or how benefits are applied. Most Medicare Advantage plans also offer prescription drug coverage; and if you have Part C, you likely will not need a Medicare Supplemental Plan.
- Part D is prescription drug coverage that is offered by private insurers. Each insurer has its own formulary, which determines preferred drugs and their costs.
What Medicare doesn’t cover
There are some services that Medicare doesn’t cover at all. Some of these include:
- Skilled nursing care: While Part A does cover certain services in a skilled nursing care facility, you must meet certain conditions to be eligible. And, after 20 days in a facility, you will pay $144.50 per day up to 100 days, and then full costs for any days thereafter.
- Long term care (custodial care): Medicare does not cover any costs related to long-term care needs if it is the only type of care you need.
- Chiropractic services: Part B will cover a medically necessary manipulation of the spine by qualified chiropractors or providers. Any other services or tests performed by a chiropractor are not covered.
- Acupuncture: Medicare does not cover any costs associated with acupuncture.
- Routine eye or dental care: Part B covers some preventive and diagnostic eye services, like a yearly eye exam or glaucoma test. Eye exams for contacts or glasses are not covered. Medicare does not cover any dental exams, services or devices, including dentures; however, Part A may cover some dental costs if performed while in a hospital.
- Hearing/balance exams: Part B will cover diagnostic and balance exams if ordered by your doctor. Routine hearing exams and hearing aids are not covered.
- Cosmetic surgery: Unless needed to repair a malformed or malfunctioning body part, Medicare does not cover cosmetic surgery.
- Routine foot care: Medicare does not cover routine foot care. Part B will, however, cover podiatrist services for medically necessary care.
- Care outside of the U.S.: Generally, Medicare does not cover any health-care services obtained while outside of the U.S. Part A may cover inpatient hospital services, but you must meet certain eligibility requirements.
To find out if a service or device is covered by Medicare, use the search tool provided on Medicare.gov.
How to fill the gaps in coverage
You can obtain coverage for some of the services that Medicare does not cover by purchasing a Medicare Supplemental Plan (also known as Medigap). These plans are sold by private insurance companies. To purchase a plan (there are usually 10 to choose from—Plans A through N), you must already have Medicare Parts A & B and cannot be on Medicaid.
This article contains general information. Individual situations are unique.
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