A Question from a Medicare Beneficiary Regarding Whatever Medicare Parts A and B Do Not Cover

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Medicare Part A covers hospitalizations, surgeries, long-term care, and certain home care. Medicare Part B covers doctor visits, outpatient therapy, proactive therapies, and necessary hardware. As a result, it is essential to investigate any coverage gaps before deciding whether a Medicare beneficiary should include Medicare Advantage, which is Part C, or Medicare Part or Medicare insurance in their overall health care strategy.

What kinds of medical services do Medicare and Medicaid not pay for?

The following medical procedures are not included in the scope of coverage provided by Original Medicare.

  • Prescribed medication
  • Long-term care services
  • Both taxes and co-pays are required
  • The use of hearing devices
  • Regular eye care
  • Regular dental treatment, involving implants

Most prescribed drugs are not covered by Original Medicare; however, beneficiaries can address this coverage gap by enrolling in either Medicare Part D or Medicare Advantage during the yearly open enrollment season, which runs from October 15 through December 7.

There are even some exemptions to the exclusions.

In certain situations, Medicare Part B will pay for medications that are to be taken outside of the hospital.

The administration of medications that are supported by Medicare Part B normally takes place in an outpatient medical environment, such as a doctor’s office or hospital clinic.

Examples of such medications include those that are injected for osteoporosis and those that are prescribed to be used in conjunction with long-term medical devices.

Care for the Elderly

When it comes to out-of-pocket expenses, long-term care often accounts for the largest share.

The Original Medicare coverage does not extend to long stays in nursing homes or assisted living facilities, as well as visits to domestic care centers. Care that is highly technical and received in a skilled nursing facility is covered under Medicare Part A for up to 100 days throughout the beneficiary’s benefit term.

Medicare will pay for treatment in full if the patient has been an inpatient at a hospital for at least three days and if they are admitted to a facility typically within the first 30 days following being discharged from the hospital.

It is essential to bear in mind that Medicare Advantage does not cover expenses that relate to longer-term care, and it is critical to remember this fact.

In this scenario, purchasing private long-term care insurance is going to be your best bet.

The Story

However, beneficiaries are liable for deductibles and co-payments when they use Original Medicare. Original Medicare covers hospital stays, services provided by doctors, and outpatient care.

Beneficiaries are expected to pay $389 per day for prolonged hospital stays from days 61 through 90, and $778 for stays longer than 90 days. The Part A deductible is $1,556, and the total amount due for extended hospital stays is $778.

Beneficiaries need to keep in mind that there are “lifetime reserve days.” After the initial 90 days, Medicare will pay for an additional 60 days. When this threshold is reached, beneficiaries are responsible for the remaining costs associated with their hospital stay.

After meeting a threshold of $233, users of Medicare Part B who seek physician assistance, laboratory tests, and X-rays are responsible for paying 20 percent of the total cost.

If an individual does not have any other kind of coverage, a Medigap or Medicare Advantage plan might help to augment the expenditures. Original Medicare does not pay for hearing devices, regular eye care, or regular dental services.

This includes testing needed to use or fit assistive hearing aids, unless a physician comes to conduct a test in an urgent situation or to decide if a patient requires immediate hospital attention, including cases to identify light-headedness or nausea.

Because glasses and corrective lenses are not insured, the same rationale that pertains to eye care emergencies also applies to vision care.

To be insured for dental procedures like fillings and most surgical removals, you will need to buy separate dental insurance coverage.

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