Medicare is a health insurance program issued by the government. The program covers people aged 65 or older, certain people with disabilities, and patients with end-stage renal diseases. It encompasses several plans and is divided into four parts with certain services – A, B, C, and D. Out of these, Part A is free for those who’ve paid Medicare taxes for at least ten years, but the others have to pay a premium.
Even though the program is helpful for many, some Medicare plans are complicated in terms of coverage. This makes it difficult to understand. They might cover various aspects of health care, but many conditions are not covered as well, some of which include:
Dental care
Medicare plans may cover basic health care services and X-rays, but they have a limit of $1,500 annually. Medicare plans may not cover routine dental checkups and treatment of certain dental services. They also do not cover dentures and fillings. However, in the case of emergency hospitalization, patients can use Part A to pay off certain dental services.
Long-term hospitalization
Usually, all Medicare plans cover up to 90 days of hospitalization. The benefit period begins on the first inpatient day at a hospital or nursing facility and ends when inpatient care isn’t received for more than 60 days. Furthermore, if the patient suffers two or more accidents within 60 days, the Medicare plans cover the cost for only one of them.
Cosmetic surgeries
Original Medicare plans do not cover the costs of cosmetic surgeries. However, if it is due to a deformity or injury, the patient can use Medicare plans to pay for certain health care services such as artificial limbs, artificial eyes, and replacement parts. Furthermore, breast cancer survivors can also employ Medicare to pay for a post-mastectomy breast prosthesis.
Health care received while overseas
In most cases, original Medicare plans do not include health care expenses incurred outside the country. However, the expenses can be paid for in rare and specific circumstances, which include the unavailability of the nearest US hospital close to the borders. In addition, certain plans may also cover healthcare services received on a ship in US territorial waters.
Medicare Advantage plans offered by private healthcare insurance companies cover the exclusions from parts A and B of Original Medicare. Some common examples of such plans are Health Maintenance Organization, preferred Provider Organization, Private Fee-For-Service Plans, and Special Needs Plans. For example, United Healthcare offers Part C Medicare Advantage with $0 copays, dental benefits, prescriptions, vision benefits, hearing benefits, and exclusive OTC credits. All private insurance providers who offer such plans with Original Part A and B benefits must follow the rules set by Medicare.
Medicare does not cover some types of durable medical equipment and supplies. These include the equipment needed for assistance outside or inside the home, such as motorized scooters, grab bars, and stairway elevators. Items such as catheters, incontinence pads, compression leggings, and surgical facemasks can be used only once. Also, Medicare doesn’t pay for home modifications, such as constructing ramps for better wheelchair access.
