What Medicare doesn’t cover

Obtaining senior health insurance is important, but it’s just as vital to understand what is and isn’t covered. Medicare can provide coverage for numerous health-related issues, but there are some areas where supplemental insurance may be necessary.

Generally speaking, you can depend on Medicare Parts A and B to cover:

  • Hospital care
  • Medically necessary services
  • Skilled nursing facility care
  • Preventative services
  • Nursing home care
  • Hospice
  • Home health services

“Your coverage can be impacted by where you live.”

Keep in mind that nursing care is for medical issues, not custodial. For help with day-to-day tasks, a long-term care insurance policy is necessary to cover costs.

Additionally, your coverage can be impacted by where you live, as both federal and state laws play a part in what Medicare covers. National coverage decisions are made by the Medicare program itself, while local decisions are made by the companies that process claims for Medicare.

In order to find out if a service or item is covered under Medicare, you should ask your doctor or health care provider. If you require this service or item but your provider is unsure if Medicare will cover it, you will be required to read and sign a notice saying you may have to pay for it out of pocket.

You can also visit the official Medicare website and plug in a service or item to see if it’s covered.

As for Medicare prescription drug plans, known as Part D, each one has its own list of covered drugs based on what tier they’re placed in. In general, the lower the tier, the less expensive the drug will be.

Excluded services
Among the offerings not covered by Medicare are:

  • Long-term care
  • Most vision, foot, hearing and dental care
  • Cosmetic surgery
  • Alternative medicine, such as acupuncture

Additionally, while Medicare does provide coverage for hospital costs, not all charges will be taken care of by your insurance. Miscellaneous hospital expenses, such as inpatient charges for a private room, will not be covered. Non-emergency transportation and copies of X-rays are also excluded from your coverage. Finally, Medicare typically does not pay for health care services you receive outside the U.S.

Extended coverage
There are various supplemental insurance plans for Medicare known as Medigap policies. These can be used to shore up holes in your coverage.

Additionally, Medicare Advantage plans, known as Part C, can be more comprehensive than original Medicare, as these policies are provided by private insurers.

However, both options will come with their own unique expenses, so it’s important to weigh what services you will receive against the costs of supplemental coverage.

Pete Blasi