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What Medicare Covers - And What It Doesn’t

Posted by Brianna Maguire on Feb 12th 2020

On Medicare? Confused about what it covers? With all the different Medicare plan options, it can be a jungle to understand what is and isn’t covered under your plan. That’s why we created this simple guide to help you understand what your insurance can help you pay for.

What’s Medicare?

Medicare is a nationwide health insurance program managed by the United States Government. It provides health care coverage for those 65+, and there are a few different plan types. Most people will enroll in both Part A and Part B.

Medicare Part A

This is the most basic form of Medicare and is used for inpatient and hospital coverage. For most people, this Part doesn’t require any premiums - as long as you’re 65+, have worked at least 10 years, and paid Medicare taxes while you worked. Keep in mind that Part A isn’t really “free” - you’re still responsible for a deductible in most cases, and often a co-pay.

Part A covers:

  • Inpatient care in a hospital
  • Skilled nursing facility care (only for those where a doctor has recommended it, and if the need was determined during a hospital stay)
  • Hospice care
  • Home Health Care in some situations. You must be under the care of a doctor, homebound, and the services must be:
          • Medical social services
          • Occupational therapy
          • Speech-language pathology services
          • Part-time skilled nursing care
          • Part-time home health aide services

Medicare Part B

Part B is medical insurance that covers some non-hospital expenses, like blood tests, doctor’s visits, x-rays, and more. Since its a medical insurance, you do need to pay monthly premiums and a deductible before the benefits kick in.

Part B covers:

  • Doctor’s appointments - “wellness checks”
  • Preventive services, like screenings
  • Ambulance services
  • Durable Medical Equipment (DME) if prescribed by a doctor. This equipment includes walkers, blood sugar monitors, commode strips, crutches, and more. You’ll need to purchase these through a vendor that accepts DME prescriptions. Keep in mind that for DMEs, you’re often responsible for a 20% co-pay.
  • Mental health services (inpatient and outpatient treatments as well as partial hospitalization)
  • Yearly depression screenings
  • Clinical research studies (to compare different treatments or study how well new treatments are working)
  • Some prescription drug coverage

Medicare Part C, or “Medicare Advantage”

Part C, commonly called “Medicare Advantage,” bundles up the other types of Medicare into one package. It’s completely optional, but you must also have Part A and Part B in order to enroll. Medicare Advantage includes all the benefits that Part A and Part B include, and it may cover some additional services like eye exams, hearing aids, and dental care.

Unlike Part A and Part B, Part C is offered through private insurance companies, so what is and isn’t covered depends on your specific plan.

Keep in mind that everything listed above (in Part A and Part B) is covered by Medicare Advantage - you’ll just need to reach out to your insurer to see what else is covered.

What Medicare Doesn’t Cover:

With the exception of Medicare Part C, or “Medicare Advantage,” there are a number of services that Medicare plans do not cover.

If you’re a recipient of Medicare Part A and/or Part B, your plan will not cover:

  • Homemaker services (shopping, cleaning, laundry)
  • Custodial or personal care (bathing, dressing, using the bathroom)
  • Acupuncture
  • Long-term care
  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Hearing aids and exams for fitting them
  • Routine foot care
  • Adult diapers and other absorbent incontinence products

What’s Medicaid? Is that the same as Medicare?

Medicaid is a federal and state program that helps with medical costs for those that are low income. These benefits vary state by state, and you can visit https://www.medicaid.gov/ to check your eligibility.

Still not sure?

If you have a specific service in mind and don’t see it listed here, you can check to see if it’s covered on the Medicare website: https://www.medicare.gov/coverage. Just use the search bar to discover more information on the product or service you’re looking for.

Quick word of advice: there are lots and lots of websites out there that claim to provide Medicare plan information. We recommend that you stick with the Medicare.Gov website for the best, most up-to-date information.

Do you accept insurance?

Unfortunately, Carewell cannot accept insurance as a form of payment. However, if your insurance provides reimbursements, we will happily provide you with the appropriate invoices.

We hope this helps! At Carewell, we want to make sure you have all the products and information you need to make your caregiving journey easier. Reach out if there’s any other way we can help!

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