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Since 2011, we've helped more than 5 million people understand their Medicare coverage.
A PROPERTY OF HEALTHINSURANCE.ORG, LLC, A NON-GOVERNMENTAL ENTITY
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800– MEDICARE to get information on all of your options.
Q: What kinds of health-related services are not covered by Medicare?
A: Medicare beneficiaries receive comprehensive coverage for most health issues and the treatment of acute illness, but there are some expenses Medicare doesn’t cover. To make sure you are covered for some of these services, you may choose to purchase additional insurance. Here’s what you need to know:
The following are never covered by Medicare Part A or Part B and are unlikely to be covered by Medicare Advantage plans:
Medicare has strict rules about services it will cover, and it excludes many services from coverage. These rules are specified in the law, so while many commercial insurance plans that cover people who aren’t eligible for Medicare are able to make exceptions to their rules – and choose to cover certain services in certain circumstances – Original Medicare (Part A and Part B) can’t usually do this.
Medicare Advantage plans may cover the following services that are excluded by Original Medicare:
Because the insurers offering these plans are paid based on what Original Medicare would pay for care, they usually don’t cover additional types of medical care not reimbursed by Original Medicare (e.g. diabetic foot care).
Medicare beneficiaries who don’t want to use Medicare Advantage may choose to purchase private dental or vision insurance so they have coverage for these services.
These services are only covered under private Part D prescription drug plans (including Medicare Advantage Prescription Drug plans):
Before the Affordable Care Act, preventive screening exams generally were not covered by Medicare, but numerous screening tests are now covered under Medicare Part B because of the law.
To cover long-term care, some Medicare enrollees purchase private long-term care insurance, although this can be quite expensive. Medicaid provides coverage for long-term care services in every state, and covers a number of other things Medicare doesn’t pay for, like non-emergency medical transportation.
If Medicare decides not to pay for a service you need, you can appeal (although you’ll appeal to your insurer if you have a Medicare Advantage plan). But if the service isn’t covered at all under Medicare, then an appeal probably won’t benefit you.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals.In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive.
The number of doses of COVID-19 vaccine Medicare enrollees will receive varies based on medical history and the specific vaccines received.
Modern Medigap plans do not include prescription drug benefits. Instead, Medicare offers prescription drug coverage under Part D. Medicare enrollees can get prescription coverage either by switching to a Medicare Advantage plan or by purchasing a stand-alone Medicare Part D plan (PDP) to go along with Original Medicare.
Medicare reimbursement refers to the payments that hospitals and physicians receive in return for services rendered to Medicare beneficiaries. The reimbursement rates for these services are set by Medicare, and are typically less than the amount billed or the amount that a private insurance company would pay.
If you're enrolled in a Medicare Advantage plan and you're not happy with it, you can switch plans during Medicare's annual open enrollment period. Here are four reasons why you might change coverage.
For half a century, Medicare has provided comprehensive health insurance coverage to America's seniors. But dental coverage isn't included in Original Medicare or Medigap plans.
Medicare won’t pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions.
The number of doses of COVID-19 vaccine Medicare enrollees will receive varies based on medical history and the specific vaccines received.
Modern Medigap plans do not include prescription drug benefits. Instead, Medicare offers prescription drug coverage under Part D. Medicare enrollees can get prescription coverage either by switching to a Medicare Advantage plan or by purchasing a stand-alone Medicare Part D plan (PDP) to go along with Original Medicare.
Medicare reimbursement refers to the payments that hospitals and physicians receive in return for services rendered to Medicare beneficiaries. The reimbursement rates for these services are set by Medicare, and are typically less than the amount billed or the amount that a private insurance company would pay.
If you're enrolled in a Medicare Advantage plan and you're not happy with it, you can switch plans during Medicare's annual open enrollment period. Here are four reasons why you might change coverage.
For half a century, Medicare has provided comprehensive health insurance coverage to America's seniors. But dental coverage isn't included in Original Medicare or Medigap plans.
Medicare won’t pay for routine vision services, but it will cover the cost of diagnosing and treating most eye diseases and conditions.
