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What Medicare Advantage and Original Medicare Coverage Doesn’t Actually Pay For

things medicare doesn't pay for
Medicare has high flexibility when it comes to inpatient, outpatient, and prescription coverage. However, it’s not universal. Medicare works within the confines of what’s medically necessary and whether the medical professionals choose to accept Medicare. It’s important to understand this so that you are not in for an unpleasant surprise when you are billed for something Medicare doesn’t cover.

Treatment from Doctors who don’t accept Medicare

First and foremost, you need to check to see if the doctors you’ll get treatments from will accept Medicare assignment. Even if you get a service that Medicare would normally cover, it won’t work if your healthcare provider doesn’t accept it. In terms of Medicare Advantage, healthcare providers outside your network may refuse to treat you even if they accept traditional Medicare. Checking eliminates the possibility of you having to pay a large bill by yourself.

Dental, Vision, and Hearing

Original Medicare (Part A and B) does not cover dental, vision, or hearing services. You will need to get separate insurance in order to have those treatments covered. Your other alternative is to enroll in a Medicare Advantage plan. It is a bundle package including your inpatient, outpatient, and in some cases, drug coverage. Dental, vision, and hearing coverage is a major selling point. If you already have Original Medicare, you can make this switch during the Annual Enrollment Period from October 15 to December 7.

Long-term/Custodial Care

Long-term care, also known as custodial care, is where you get daily assistance for everyday activities such as bathing and getting out of bed. The reason why Medicare doesn’t cover this is because it’s not a form of medical treatment. A person doesn’t have to be a healthcare professional to do this. However, you can get a separate long-term care insurance plan to help mitigate these costs.

Cosmetic Surgery

While Medicare Part A would cover surgeries in the inpatient setting, that coverage does not apply to cosmetic surgery. Medicare only covers what is medically necessary – not elective.

Excess Charges

This applies to some healthcare providers who do not accept Medicare assignment, but will work out a deal with your Medicare plan. These are non-participating healthcare professionals. You’ll still get coverage, but not like what you would get from a participating doctor. In this case, you’ll have to pay up to an additional 15% for a non-participating provider. The only exception is if you get a Medicare Supplement plan. A Supplement plan can cover excess charges, but Medicare itself doesn’t.

Don’t Let Excess Charges Take You by Surprise

What Medicare covers far exceeds what it doesn’t. These are only a few types of services you can’t get coverage for, but it’s important to look at the bigger picture. Wise Up Financial gives you the perspective and the knowledge necessary to get the most coverage and work around the limitations. If you want the best policy possible, call us today at 830-308-0123.

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If you’ve enrolled in Medicare and want to learn more about your coverage, then we’re here to help. Feel free to reach out to us today and we will find a time to talk more about your specific coverage and the ways you can use it.

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