Services and products that Medicare doesn't cover
July 1, 2018
Each month I enjoy sharing with readers the many facets of Medicare. The enrollment periods, coverage under the different parts of Medicare, types of providers available, how to avoid penalties related to late enrollment, and how to pay for Medicare.
However, there are certain services and products that Medicare does not cover under Original Medicare; Part A & Part B, which is what is available to most beneficiaries in Alaska. As you budget your health care dollars, it is important to know what you will have to pay for outside of Medicare. It is also important to note that you may have or may be able to purchase other insurance that covers these services.
Some of the items and services that Medicare does not cover include: Long-term care – Long Term Care services may be provided by an assisted living home, nursing home, or family care home. They may also be provided by personal care attendants, chore providers, etc. There are a wide variety of companies that offer long –term care coverage and have a range of plans to offer. Medicare does provide coverage in a Skilled Nursing Facility (if you meet the qualifications for medical necessity) for a period of time.
Dental Services are not covered by Medicare. Routine dental care like x-rays, cleanings, crowns, fillings and dentures are not considered medical care. There are companies that offer dental coverage outside of Medicare. That being said Medicare will pay for dental services that are an integral part of either a covered procedure, for example, reconstruction of the jaw following an accidental injury or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw.
Routine vision exams for the purpose of determining the prescription for eyeglasses or contact lenses are not covered by Medicare. However, Medicare does provide coverage for certain eye care services. For example, if you have a chronic condition of the eye or are considered at high risk for glaucoma Medicare will provide for an eye examination. Medicare may cover treatment for people who experience age-related macular degeneration (AMD) and other vision problems. Medicare will cover an eye exam to diagnose potential vision problems due to a serious eye condition like retinopathy due to diabetes or other health disorders. Medicare covers surgery for cataracts and will provide one pair of eyeglasses after the surgery. Be sure to use Medicare providers and suppliers to ensure coverage.
Medicare does not cover experimental or alternative procedures and treatments such as acupuncture and many chiropractic services. Medicare will cover manipulation of the spine when medically necessary to fix a subluxation of the spine in order to bring the bones of the spine back into position.
Medicare will not cover cosmetic surgery, that is, surgery designed solely for improving ones appearance. However, Medicare may cover Plastic Surgery – surgery that reconstructs body defects and is needed to improve the function of a malformed body part or if it is related to an accidental injury. Medicare does cover breast prostheses for reconstruction after a mastectomy due to breast cancer.
Medicare does not cover hearing aids or the examination needed for prescribing or fitting of hearing aids. Medicare may cover cochlear implants to treat severe hearing loss.
Personal Care is not included in Medicare’s benefits Personal care includes assistance with activities of daily living such as bathing, dressing, transferring, or eating. Medicare is medical insurance and basically covers medical services. If a Medicare beneficiary is also eligible for Medicaid, they may qualify for these services. Check with your Medicaid case manager.
Medicare does not cover Chore services or custodial care which includes cooking, shopping, cleaning, laundry.
Medicare does not provide coverage for non-emergency transportation benefits.
While Medicare does provide coverage for a wide variety of preventive services, routine foot care such as pedicures or toenail trimming is not included.
Medicare does not usually cover care received outside of the United States. Medicare does provide coverage in all 50 states and US Territories.
It is important to know what Medicare will and won’t cover so that beneficiaries aren’t surprised by unexpected costs and can make provision for those services that are not included. Be alert to advertisements that promise you Medicare coverage for the non-covered items that are described above. When in doubt, contact the Medicare Information Office at 1-800-478-6065 for clarification of your benefits or assistance in finding companies that can provide additional insurance.
Nila Morgan is a Certified Medicare Specialist who works at the Anchorage Senior Activity Center.