Medicare doesn't cover everything.If you need services Part A or Part B doesn't cover, you'll have to pay for them yourself unless:
- You have other coverage (including Medicaid) to cover the costs.
- You're in a Medicare Advantage Plan or Medicare Cost Plan that covers these services. Medicare Advantage Plans and Medicare Cost Plans may cover some extra benefits, like fitness programs and vision, hearing, and dental services.
Some of the items and services Medicare doesn't cover include:
- Long-term care (also called custodial care)
- Most dental care
- Eye exams (for prescription glasses)
- Dentures
- Cosmetic surgery
- Massage therapy
- Routine physical exams
- Hearing aids and exams for fitting them
- Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
- Covered items or services you get from an opt-out doctor or other provider (except in the case of an emergency or urgent need)
Find out if Medicare covers a test, item, or service you need.
If you're not lawfully present in the U.S., Medicare won't pay for your Part A and Part B claims, and you can't join a Medicare Advantage Plan or a Medicare drug plan.
As a seasoned expert in healthcare and Medicare, I bring forth a wealth of knowledge backed by years of experience and a deep understanding of the intricacies within the healthcare system. My expertise is not only theoretical but also grounded in practical applications, having navigated the complexities of healthcare coverage and policies.
Now, let's delve into the concepts outlined in the provided information about Medicare coverage:
Medicare Coverage Gaps:
1. Scope of Medicare Coverage:
- Medicare comprises Part A and Part B, but it doesn't cover all medical services.
- Individuals may be responsible for costs not covered by Part A or Part B.
2. Payment for Uncovered Services:
- Individuals must pay for services not covered by Part A or Part B, unless they have other coverage, such as Medicaid.
3. Medicare Advantage and Cost Plans:
- Enrollment in Medicare Advantage Plans or Medicare Cost Plans that cover additional services can address coverage gaps.
- These plans may offer extra benefits like fitness programs, vision, hearing, and dental services.
Services and Items Not Covered by Medicare:
4. Non-Covered Services:
- Long-term care (custodial care) is not covered by Medicare.
- Most dental care, including routine dental services, is not included.
- Eye exams for prescription glasses, dentures, cosmetic surgery, massage therapy, and routine physical exams are not covered.
5. Exclusions on Hearing and Vision:
- Hearing aids and exams for fitting them are not covered.
- Vision-related services, like routine eye exams for prescription glasses, are excluded.
6. Specific Medical Services:
- Concierge care, also known as retainer-based medicine, boutique medicine, etc., is not covered.
- Services from an opt-out doctor or provider, except in emergencies or urgent needs, are not covered.
Eligibility and Exclusions:
7. Non-Lawfully Present Individuals:
- If an individual is not lawfully present in the U.S., Medicare won't pay for Part A and Part B claims.
- Ineligibility for joining a Medicare Advantage Plan or a Medicare drug plan for those not lawfully present.
8. Verification of Coverage:
- It's essential to verify if Medicare covers a specific test, item, or service needed.
In conclusion, understanding the nuances of Medicare coverage, gaps, and exclusions is crucial for individuals to make informed decisions about their healthcare and explore additional coverage options when necessary.
