What Medicare Does and Does Not Cover
March 30th, 2016Figuring out which Medicare plan is right for you and your medical needs can be tricky. You can choose from a variety of different plans. There is Original Medicare, which includes Part A and Part B, or you can choose a Medicare health plan, like Medicare Advantage, which is often referred to as Part C and also includes Part A and Part B. You could also choose a Medicare Medical Saving Account (MSA) plan. If that wasn’t enough, there are other Medicare health plans that only cover Part B services. Below we will break down what is covered by each plan so that you can decide what makes sense for you.
Original Medicare
Cost
On average in 2016, consumers are paying around $104.90 monthly for Part B premiums. Most consumers will have to pay a deductible and some percentage, or coinsurance, for Part A and B services.
Medicare Part A is hospital insurance, so it covers things like:
- Hospital Care
- Skilled Nursing Facility Care
- Nursing Home Care
- Hospice
- Home Health Services
- Medically Necessary Services
- Preventive Care
- Clinical Research
- Ambulance Services
- Durable Medical Equipment (DME)
- Mental Health
- Inpatient
- Outpatient
- Partial Hospitalization
- Second opinions prior to surgery
- Some outpatient prescription drugs
Medicare Part B is considered medical insurance. Part B covers:
Specific Services and Tests Covered by Part B:
Medicare Part D
This plan just adds prescription drug coverage to other plans. You can get it with the Original Medicare or the Medicare Health Plans. If you don’t decide to enroll when you are first eligible you may have to pay a late enrollment fee.
Medicare Advantage (Part C)
Coverage for this plan is generally provided by a private insurance company that is approved by Medicare.
Cost
On average in 2016, consumers are paying around $104.90 monthly for Part B premiums. If the service is considered medically unnecessary you may have to pay for it out of pocket. Check with your health care provider before getting the service or procedure.
Coverage
Medicare Advantage covers everything that Part A and Part B cover, except hospice care. You are covered for hospice care, emergency and urgent care no matter what.
Medicare MSA Plan
MSA plans broken down
1. High deductible - It is a special Part C plan that will only cover you after you have met your high yearly deductible.
2. MSA - This is a savings account of sorts that deposits money into your account and you can choose to use that money towards your health care costs.
Coverage
MSA plans cover all services that are covered by Medicare Advantage Plans. There are also extra benefits such as dental, vision and long term care available at an additional cost
Other Medicare Health Plans
- Medicare Cost plans
- Demonstrations/ Pilot Programs
- Programs of All-Inclusive Care for the Elderly (PACE)
- Medication Therapy Management programs
What Medicare Doesn’t Cover
- Long-Term care
- Most Dental Care
- Eye Examinations related to prescribing glasses
- Dentures
- Cosmetic Surgery
- Acupuncture
- Hearing Aids and Exams for fittings
- Routine foot care
