Medicare doesn’t cover everything. Some of the areas that often fall outside the umbrella of the health program for adults 65 years of age and older, for certain people with disabilities and for severe kidney patients are:
- Long term care. Services that include medical and non-medical care provided to individuals who are unable to perform basic daily tasks, such as dressing or bathing, on their own. These services are often offered in homes, in assisted living communities, or in homes. These are services that may be needed at any age.
- Much of dental care
- Eye exams for prescription glasses
- New dentures
- Cosmetic surgeries
- Hearing aids and tests to fit them
- Foot care
If there are other services you need, your doctor can find out whether or not they are covered by Medicare.
What is it and who qualifies for Medicare
Medicare is a federal health program whose goal is to provide medical and hospital care to older adults.
As of 2020, Medicare has 44 million beneficiaries. But enrollment is expected to rise to 79 million by 2030.
The program is composed of three parts that cover different services:
- Medicare Part A (hospital insurance). CSome inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Medicare Part B (health insurance). Cudder certain medical services, outpatient care, medical supplies, and preventive services.
- Medicare Part D (prescription drug coverage). It helps cover the cost of prescription drugs, including many vaccines or recommended vaccinations.)
When enrolling in Medicare, you must choose what type of coverage you want. There are two options:
Medicare Original. IIncludes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). The beneficiary pays for the services as they are received. When you receive services, you will pay a deductible at the beginning of each year, and you generally pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan (Part D).
This type of Medicare pays for much, but not all, of the cost of covered health care services and supplies. A Medicare Supplement Insurance (Medigap) policy can help pay for some of your remaining health care costs, such as copays, coinsurance, and deductibles. Some Medigap plans also cover services that Original Medicare doesn’t cover, like medical care when you travel outside of the United States.
Medicare Advantage. These “integrated” plans include Part A, Part B, and usually Part D. Most plans offer additional benefits that original Medicare does not cover, such as vision, hearing, and dental care. Medicare Advantage plans have annual contracts with Medicare and must follow Medicare coverage rules.
Each Medicare Advantage plan may charge different out-of-pocket costs. They may also have different rules about how to get services.
The Medicare Open Enrollment Period runs from October 15 to December 7 of each year.
Sources: Medicare.gov, CMS.