Medicare Coverage

You might have heard that Medicare is broken down into two parts; Part A (Hospitalization) and Part B (General Medical). But you’ll want to research exactly what they cover so that you are better informed about how you’ll be covered. Below are some of the more frequently asked “does Medicare cover this” questions I’ve been asked by my clients. If something is not on the list, please don’t hesitate to contact me and ask.

Medicare does not cover acupuncture. Medicare, however, does cover Chiropractic under certain conditions. Part B will cover 80% of the cost for spinal manipulation “if medically necessary to correct a subluxation.” There’s no cap on the number of visits to a chiropractor. Some Medigap plans will cover the remaining 20% of the cost. Contact me to learn more.

Part B covers emergency air and ground transportation for most medical emergencies. Since Part B cover it, deductibles and the 20% coinsurance will apply.

Ambulances can be very expensive. Lucky, all Medigap plans will pay all, or a portion of, ambulance bill, reducing or eliminating the expense for you.

A lot of dental procedures can be pricey. Part A & Part B do not cover dental procedures, but may cover certain dental procedures if it requires hospitalization.

Most Medicare Supplements and Medicare Advantage Plans have additional riders that can cover dental procedures for a small additional premium.

Medicare covers medically necessary foot care (such as bunions or hammer toes,) but does not cover routine foot care (such as feet soaking, callouses, etc.)

Medicare does not pay for gym memberships. However, Certain Medigap plans do have gym membership programs (such as Silver Sneakers or Silver & Fit) that will sponsor your gym membership with participating gyms.

Medicare does not cover hearing aids. However, Anthem’s Medigap Plan “Innovative F” does offer some hearing aid coverage. You may still need to pay some out of pocket for the hearing aid, however.

Yes, Medicare covers Hospice Care, generally at no cost to you. Respite care, however, can cost you up to 5%.

All Medicare Supplement plans pay all or part of the respite care, so it can reduce or eliminate those costs as well.

If there is a medically neccessary requirement due to morbid obesity, Medicare will cover a laparoscopic surgery.

Part A would cover the hospitalization costs (Part A Deductible applies)

Part B would cover the professional and out-patient care (Part B Deductible and 20% coinsurance applies)

Medigap plans will pay some or all of these costs.

Yes, it’s covered under your Part B (20% coinsurance and Part B deductible therefore apply.) However, it must be prescribed by your doctor to be covered.

Certain Medigap plans may cover the deductible and/or the coinsurance.

If you are looking for Skilled Nursing Facility, please see that separate entry.

There is no coverage for Long Term Care Facilities (commonly referred to as Nursing Homes) under Medicare or Medigap plans.

It’s no surprise that Prescriptions can be one of the most expensive parts about getting older. Unfortunately, however, the short answer is no. Neither Medicare Part A or Part B will cover prescription drugs at the pharmacy.

In order to get coverage for a prescription drug, you’ll want to look into Prescription Drug Plans and also, most Medicare Advantage Plans will cover prescriptions as well.

Each plan has a different formulary, so it’s important to compare the prescriptions you take to see if they are covered and how they are covered. This can be a daunting task to do on your own. Contact me for assistance at no cost to you.

These are covered under your Part A for a limited amount of time. There would also need to be at least 3 days of in-patient hospital stay.

You’d be responsible for the Part A deductible and a $167.50 per day copay for days 21-100. There is no coverage past 100 days.

Medigap plans will pay some or all of these costs depending on the plan.

Neither Part A, nor Part B will cover routine vision – meaning there is no coverage for normal eye examinations, glasses or contact lenses.

Most Medicare Supplements and Medicare Advantage Plans have some benefits or additional riders that you can purchase for a small additional premium to get you covered for routine eye exams and corrective lenses.

Anthem’s “Innovative F” plan has some coverage for routine eye exams and eyewear. You may be required to pay some out of pocket costs, however.

That being said, there is coverage for medically necessary eye conditions, such as macular degeneration or cataracts.