Medicare is divided into parts A, B, C, and D. These four parts cover different services, hence the need to understand your options before picking Medicare cover. Medicare is a national health insurance program curated for people with final stage renal disease, disabilities, and those aged over 65 years.
Parts A and B make up the original or traditional Medicare. It is typically offered by private entities authorized by Medicare to provide benefits to individuals who enroll. Individuals who seek to understand whether the original Medicare will serve their healthcare needs should begin by considering its scope of coverage.
Part A of Medicare is widely regarded as hospital insurance and covers inpatient care. This type covers other expenses, including hospice for terminally ill patients and the services of a stay-in skilled nurse.
Part B refers to medical insurance, mainly covering outpatient care. This insurance pays for the doctor’s services, including outpatient hospital care, lab tests, and home healthcare. Other services covered under this insurance include orthotics, mental healthcare, annual wellness clinics, prosthetics, and ambulance services.
What is not covered by traditional Medicare? This is the most common question in Medicare today. This knowledge is important to avoid paying off your pocket when seeking extra services.
Parts A and B do not cover the following:
Medicare will only cover plastic surgery that is regarded as necessary. However, cosmetic surgery majorly falls under services that Medicare is not likely to cover even in the future as the laws change.
Medicare does not cover the following services:
• Body contouring
• Tummy tuck
• Breast augmentation
• Breast lift
Original Medicare does not include some major dental work, hence the need to have a separate dental care package. The following dental care services are not covered under Medicare:
• Teeth cleaning
• Oral surgery
• Oral exams
• Root canal
• Removal of wisdom teeth
• Invisible aligners
• Dental implants
It is estimated that almost two-thirds of the population of Americans above 70 years are suffering from hearing loss. Traditional Medicare does not cover hearing aids despite contributing to the deteriorating health of senior citizens. Hearing aids are expensive, forcing many people to avoid paying for them off their pockets.
It is imperative to note that you will pay at least 20% of the cost if your doctor calls for diagnostic hearing exams. You will need to enroll in Medicare part C to have your hearing aids covered.
Parts A and B of Medicare do not cover routine eye exams or treatment yet people become prone to various eye conditions, including cataracts and glaucoma as they age. Other vision care services not covered by parts A and B include eyeglass frames and lenses and contact lenses.
Prescription drugs if one is diagnosed with eye diseases are covered separately through premiums or co-payments under part D of Medicare. For individuals who have diabetes, their Medicare will cover eye exams once a year to detect diabetic retinopathy.
Long-term Nursing Homecare
Assisted living is an option for Americans as they grow older since they require more help with daily activities. Senior citizens will only have their long-term care services paid for by Medicare if they need a skilled nurse for general wellness. In addition, Medicare will pay if the senior citizen is admitted to a nursing facility for occupational therapy, physical therapy, or wound care. However, the stay is only covered for 100 days, after which the patient will begin to pay.
If a senior citizen needs custodial care, Medicare will not cover the costs. Other services under custodial care include the following:
• Transportation arrangements
• 24-hour supervision
• Medication management
• Assistance with daily chores
• Wellness and recreational activities
Routine Physical Exams
It is essential to undertake preventive care to detect and prevent different diseases. Once enrolled in Medicare, you are eligible for a single preventive visit, dubbed Welcome to Medicare. This visit is not as detailed as an annual preventive visit, yet Medicare does not cover yearly physicals. According to the CDC, preventative care is essential in detecting severe health illnesses such as cancer.
Alternative Health Services
Medicare does not cover alternative health services such as acupuncture, massage therapy, chiropractic treatment, or physical therapy. However, from January 2020, acupuncture was added to the list of services covered by Medicare after it was proven to reduce chronic back pain. The service is closely monitored and can only be performed by professionals.
Medicare B will cover any necessary chiropractic treatments, such as when one is diagnosed with a slipped bone. However, Medicare pays 80% of the total cost while the patient is responsible for 20%. Medicare does not cover other services offered or prescribed by a chiropractor.
Since parts A and B will not offer full coverage, you’ll need to find more options, such as Medicare Advantage, often called Part C. This is not a stand-alone policy; it is meant to fill the gaps. It is offered mainly by private insurance companies.