Covered or Not Covered? The Medicare Continuum

August 11, 2017

insurance

This article will help you understand some of the services Medicare covers, specifically:

  • Services Medicare covers at no cost
  • Services Medicare doesn’t cover at all

Medicare provides valuable hospital and medical insurance benefits to 57 million American seniors, enabling them to keep healthcare costs manageable.  Still, it is important to realize that out of pocket health-related costs will likely increase throughout retirement.

Medicare is the federal health insurance for Americans age 65 and older and for certain individuals receiving Social Security disability benefits.  Medicare services are delivered through a network of government sponsored and private insurance programs.

Like most health insurance policies, Medicare incorporates a combination of premiums, deductibles and co-insurance arrangements for the services provided.  The actual out-of-pocket expenses for a Medicare enrollee are dependent upon numerous factors including the specific plans they are enrolled in and their utilization of healthcare services.

Medicare coverage is not all encompassing – it does not pay for every healthcare related expense.  On the other hand, there are a number of services that are provided at no cost.  The purpose of this article is to highlight some of the elements within each of these categories.

What Does Medicare Cover At No Cost?

We’ve all heard the saying,  “An ounce of prevention is worth a pound of cure.”   This is particularly appropriate in the context of the American healthcare system, where a high percentage of expenditures are directed toward preventable healthcare conditions.

Over the years, Medicare has increasingly included more tests at no cost to encourage enrollees to proactively manage their health by identifying adverse conditions earlier rather than later.    

The following list provides information on preventative tests covered under Medicare Part B.

More information can be obtained by searching for the booklet, Your Guide to Medicare’s Preventative Services on the Medicare.gov website.

What Services Does Medicare Not Cover?

Following is a list of broad categories of services typically not covered by Original Medicare Parts A and B.   Certain supplemental insurance policies may provide limited coverage within some of these categories.  Moreover, Medicare may provide limited coverage in specific situations, such as eye glasses following cataract surgery.

This list is taken from the Medicare.gov website and is intended to provide awareness of services that will not be covered in most situations:

  • Long Term Care (i.e. custodial care as provided in nursing homes)
  • Most Dental Care
  • Eye examinations related to prescribing glasses
  • Dentures
  • Cosmetic Surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

Again, Medicare provides valuable hospital and medical insurance benefits to 57 million American seniors, enabling them to keep healthcare costs manageable.  In addition to paying for some of the services not covered as discussed in this article, Medicare premiums will increase with inflation, and aging typically brings on more need for services like doctor visits, prescription and treatment of chronic health issues.  Being aware of what to expect with respect to healthcare costs in retirement is the first step in preparing for them.


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