We are frequently asked about of Medicare and the most frequent questions involve services and items not covered by Medicare.
A person eligible for Medicare can receive:
Part A (Hospital Insurance) which assists with inpatient hospital care, skilled nursing facility care, Hospice care and home health care.
Part B (Medical Insurance) assists with doctors and other health care provider services, outpatient care, home health care, durable medical equipment like wheelchairs, walkers, hospital beds, and many preventive services like screenings, vaccines, wellness visits, and diagnostics like x-rays, MRI’s CT scans.
Part D which helps cover the cost of prescription medications.
From year to year Medicare adds to its coverage and what may have been an item or procedure that was not Medicare allowable prior may now be covered, so keeping up with these changes can be a challenge.
For instance “Medicare generally doesn’t cover health care while you’re traveling outside the U.S. (the “U.S.” includes the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa). There are some exceptions, including cases where Medicare may pay for services you get while on board a ship within the territorial waters adjoining the land areas of the U.S. Medicare may pay for inpatient hospital, doctor, or ambulance services you get in a foreign country in these rare cases”–
• You’re in the U.S. when an emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
• You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another U.S. state when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat the emergency.
• You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether an emergency exists.
Medicare prior to 2020 did not cover virtual teleconference medical visits; now they do.
What Medicare does not cover (but keep in mind in certain circumstances there are exceptions):
Items & services reimbursable by other organizations ie. automobile insurance, workers compensation, liability insurance
Injuries caused by negligence while hospitalized ie. development of pressure ulcers, fractures from falls
Defective equipment or defective medical devices under warranty
Items that are medically unnecessary
Routine dental care
Routine eye exams (for prescription glasses or contacts)
Hearing aids and exams for fitting them
Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
Custodial (attendant) care provided by a NON trained person
Personal comfort items such as a haircut, television, radio
Each coverage situation must be reviewed on an individual basis.
Feel free to refer to links below for resource information as well as contacting us at Specialty Allocations:
We are always available. Please do not hesitate to reach out to us here at Specialty Allocations, Inc if you have any questions or concerns.
Specialty Allocations, Inc
555 Winderley Place #300
Maitland, Florida 32751