You’ve probably heard about Medicare, but do you know exactly what it covers? It might seem like something to let the program figure out, but it’s important that you also understand what’s included. Here are a few things that you might be surprised to learn are included with Medicare coverage.
10 Things You Didn’t Know Medicare Covers
First, let’s go over the basic descriptions of the parts of Medicare.
Part A is hospital insurance. This part helps cover inpatient care in hospitals, home healthcare, skilled nursing facility care and hospice care.
Part B is medical insurance. It helps cover services from healthcare providers such as doctors, outpatient care, home healthcare, preventative services and medical equipment such as wheelchairs.
Part D is drug coverage. It helps cover the cost of prescription drugs, including shots and vaccines. Part D can be purchased as a supplement to Original Medicare (Parts A & B), or it can be obtained through a Medicare Advantage Plan from an independent insurance provider, also known as Medicare Part C.
These descriptions can help you understand the general idea of what the parts of Medicare cover. However, with health insurance, there are always questions. These things might not be top of mind when you think of Medicare coverage, and it’s important to know what Medicare plan you might need for these areas of coverage.
1. Preventative Services
Medicare covers preventative services, including yearly wellness exams. It also covers preventative screenings including bone mass measurements, cardiovascular disease screenings, diabetes screens, colorectal cancer screenings and mammograms. Additionally, Medicare will cover flu shots, obesity screenings and nutritional therapy services.
2. Hearing Aids
Original Medicare (Parts A & B) does not cover hearing aids. However, there are some Medicare plans that do. Some Medicare Advantage plans offer coverage for hearing care, which can include some or all of the cost of hearing aids. This coverage may also include specialty visits for hearing tests and hearing aid fittings.
3. Some Dental Services
Medicare Part A will cover some dental services in emergency situations. Specifically, it can cover your hospital stay if you need to have an emergency or complicated dental procedure. Other dental care — such as cleanings, extractions and fillings — is not included in Original Medicare. Some Medicare Advantage plans may offer dental coverage.
Telehealth services became a necessity during the COVID-19 pandemic. As a result of the pandemic, Medicare has expanded its coverage for telehealth services. Original Medicare plans offer coverage for doctor visits held over video chat or phone calls. For most telehealth visits, you’ll pay the same amount that you would for in-person services. Some Medicare Advantage plans also include telehealth coverage.
5. Cancer Treatments
The parts of Medicare can all work together to provide comprehensive cancer treatments. This kind of treatment includes inpatient or outpatient chemotherapy, as well as inpatient and outpatient surgeries. It can also cover hospital stays, care at a skilled nursing facility and home healthcare. Additionally, it can cover blood transfusions, office visits and durable medical equipment such as walkers and supplemental oxygen.
6. Medicare Diabetes Prevention Program
The Medicare Diabetes Prevention Program is a program that qualifying individuals can enroll in to help prevent type 2 diabetes. The program has weekly group sessions over the course of six months, which provide exercise tips, weight management strategies and access to a specially trained coach to help you implement realistic lifestyle changes. After these initial group sessions, you’ll have access to monthly follow-up sessions for another six months.
7. Substance Abuse Treatment
Substance abuse treatment is a benefit that Medicare recently began offering. It provides alcohol misuse screening once per year for adults who don’t meet the medical criteria for alcohol dependency. If a primary care doctor thinks that a Medicare recipient is misusing alcohol, Medicare will cover up to four face-to-face counseling sessions per year.
Original Medicare also covers opioid use disorder treatment services that are provided in opioid treatment programs. To receive these services for free, the opioid treatment program provider must be enrolled in Medicare. Medicare can also pay a recipient’s providers for office-based opioid use disorder treatment, which can include psychotherapy and counseling activities.
8. COVID Vaccines
Medicare covers Pfizer, Moderna and Johnson & Johnson COVID-19 vaccines. The program includes booster vaccines from any of the manufacturers, regardless of which vaccine you received originally. The timeline of when you can receive these boosters at no cost depends on the vaccine that you received and the current guidelines and recommendations. You can also receive the booster vaccine sooner if you’re immunocompromised.
9. Pain Management
Medicare coverage can pay for several types of pain management. This benefit can include physical therapy and occupational therapy. It can also cover acupuncture for chronic low back pain and manual manipulation of the spine if medically necessary. These services are all covered by Medicare Part B.
Medicare Part D can also provide some drug coverage for pain management. The plan can include opioid pain medications, such as hydrocodone and oxycodone. Coverage varies by plan, and some plans have coverage rules to promote the safe use of opioids.
10. Transitional Care Management Services
Medicare may cover transitional care management (TCM) services to help you transition back into the community after staying at a facility. This coverage includes facilities such as hospitals and skilled nursing facilities. These services are designed to help you through the first 30 days after returning home from a qualifying facility stay. The healthcare providers managing this transition can also work with facility members and other caregivers to coordinate transitional care.
These services can include many components. First, your healthcare provider will create a plan based on the care you were receiving within the facility and your plans for managing care at home. The healthcare provider can also help manage medications and provide referrals or arrangements for follow-up care during this period. Additionally, you’ll receive coverage for an in-person office visit within two weeks of returning home.
Should You Purchase a Medicare Advantage Plan?
Medicare Advantage plans are an alternative way to get your Medicare coverage. These plans are offered by Medicare-approved companies and can provide most of your Part A and Part B benefits. Most Medicare Advantage plans also offer Part D coverage.
If you’re considering a Medicare Advantage plan, you’ll need to seek out companies that offer plans in your area. You’ll then need to compare each plan to see what it offers and what it would cost you. Some things to look for are the out-of-pocket costs that come with each plan, as well as which doctors and facilities accept the plan.
For many people, it can be a good idea to purchase a Medicare Advantage plan. Not only does it allow you to roll your health and prescription drug coverage into one place, but it can also provide additional benefits, including hearing benefits such as hearing aid coverage, as well as vision and dental coverage. However, it’s up to you to determine whether Original Medicare or a Medicare Advantage plan is the best option for you.
Do You Need Medigap Coverage?
Medicare Supplement Insurance policies (also known as Medigap) are a supplement to Medicare coverage. Like Medicare Advantage plans, these policies are offered by private companies and offer benefits that are not available from Original Medicare plans. Also like Medicare Advantage plans, you can choose from several options, and you would need to compare these options to find the best plan for your needs.
The biggest benefit of Medigap coverage is that it can cover the cost of medical expenses that are not paid for by Original Medicare. This feature works by reimbursing you for your out-of-pocket medical expenses. Medigap coverage can be purchased as an additional set of coverage alongside your Original Medicare plan. However, you cannot have both Medigap coverage and a Medicare Advantage plan.
Compare Medicare Plans
With so many types of Medicare plans, how do you choose? It’s all about the types of medical and healthcare services you need, as well as the plans that are available to you. This list can help you start to think about your options.
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