[embedyt] http://www.youtube.com/watch?v=8fG_05E7qL4[/embedyt]
NO! Medicare Does NOT Cover Everything!
One of the most frequently asked questions by Medicare beneficiaries is “is this service or treatment covered by Medicare?”
The Medicare program and associated Medicare health plans are extremely complex and most mature adults have difficulty understanding and remembering all of the rules, regulations and coverage.
NO! Medicare does not cover everything!
Health care services or supplies need to be medically necessary according to accepted standards of medicine to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms; therefore, if they are deemed “medically unnecessary” by health care officials, they will not be covered.
If you need certain services, treatments or supplies not covered by Medicare, you will have to pay for them privately or use supplemental health insurance to cover the costs. Even if Medicare covers a service or item, you generally have to pay deductibles, co-insurance , and co-payments.
Medicare does not cover skilled nursing or rehabilitation care for a Medicare patient:
Who was an inpatient in a hospital for less than three days, even if the admission was medically necessary.
If you are NOT admitted into the hospital but put under “Observation” you will not be covered.
Does not require daily skilled care or physical therapy.
Will not pay after the 100th day in a benefit period.
In most cases, Medicare does not pay for custodial care in the home, inpatient hospital setting or in a nursing home.
Custodial care is non-skilled personal assistance with the activities of daily living, such as eating, bathing, dressing, toileting, personal hygiene and mobility.
No Long Term Care Coverage
Medicare and most health insurance plans do not pay for long-term care for Medicare patients at home, in the community, in assisted living centers or in nursing homes. A person can pay for long-term care privately with coverage from a long-term care insurance policy, or through Medicaid if the patient is qualified.
The following care is not covered by Medicare, although coverage may be available through some Medigap or Medicare Advantage Plans:
- Routine dental care or dentures.
- Routine eye care.
- Routine foot care.
- Hearing aids and exams for fitting them.
- Acupuncture services.
- Experimental procedures.
- Cosmetic surgery
- Non-emergency transportation
- Health care while a person is traveling outside of the United States or its territories.
Medicare does cover one pair of eyeglasses with standard frames or one set of contact lenses following cataract surgery that involves implantation of an intraocular lens, subject to deductibles and co-insurance.
Medicare recipients may receive prescription drug coverage through adding a Medicare Prescription Drug Plan or getting a Medicare Advantage Plan that offers Medicare prescription drug coverage.
Prescription drugs that are listed on your plan’s, Formulary, are covered by Medicare, after the yearly deductible is met and any coinsurance payment from you has been applied. If you reach the coverage gap of your Medicare drug plan, you will have to pay for a percentage of the cost of the medications until you reach the end of the coverage gap. You will be provided with written notice if your Medicare Prescription Drug plan makes a determination the requested drug is not covered.
You have a right to file a request for an expedited appeal of this determination.
If Medicare or the health care provider thinks Medicare will not pay for services or items, you will receive a written notice called Advance Beneficiary Notice of Non-Coverage. The ABN lists the items or services Medicare isn’t expected to pay for, an estimate of the related costs, and the reason why Medicare may not pay.
Examples of ABN include:
- A hospital states you no longer need continued inpatient hospital care.
- A home health agency or hospice provider makes changes to, reduces or ends your services.
- A hospital states you no longer need continued inpatient hospital care.
Receiving an ABN from a provider is not an official denial of coverage by Medicare.
You may request a continuation of services with the understanding you may be responsible for payment. You can request an expedited or fast appeal of the denial by calling the phone number listed on the ABN by the deadline date and time specified on the form. If your provider was required to give you an ABN but failed to do so, the provider may be required to reimburse you. Note than an ABN is not required for items or services Medicare never covers.
We are an independent Medicare, Insurance and Financial services agency. We are an independent Medicare, Insurance and Financial services agency.
Please share this information with everyone on your email list.
