Will Medicare Cover the Healthcare I Need?

That’s an excellent question, and one that lots of seniors ask. Unfortunately, the answer is, “it depends”.

Medicare can be a godsend for many 65+-year-olds, providing welcome relief from high health insurance premiums. However, the program’s ins and outs can be confusing. It can take time and effort to figure out if a specific procedure is covered. And there are some services that aren’t paid for by the program.

Here’s an overview of Medicare and what it covers, as well as suggestions for how to get more information. We’ll also introduce you to Livewell by Blakeford, a revolutionary suite of benefits that allow you to live at home as long as possible.

Intro to Medicare

This federal government health insurance is for people 65 and older (as well as younger people who have certain illnesses or disabilities). Medicare has four parts — A, B, C, D.

Medicare helps contain medical costs as you age, but it doesn’t pay for everything. With original Medicare (Parts A and B), you can visit any doctor that accepts Medicare, and the program will cover most of the cost.

Medicare Part A (hospital insurance)

Medicare Part A pays for inpatient care in a hospital. Part A also helps cover a limited number of days in a skilled nursing facility for rehabilitation. Finally, Part A covers hospice care and some home health care, but not custodial or long-term care.

If you or your spouse paid Medicare taxes for at least 10 years, there’s no premium for Medicare Part A.  There is a deductible and coinsurance, although there’s no coinsurance for the first 60 days of inpatient hospital care. Patients pay a set day rate for the 61st through 90th day of hospitalization, and more after that.

Medicare Part B (medical insurance)

Medicare Part B pays for doctor visits and other medically necessary services and supplies, including preventive services, ambulance services, durable medical equipment, mental health coverage and some outpatient prescription drugs.

There’s a monthly premium and an annual deductible. Once the deductible is met, you typically pay 20% of the Medicare-approved amount for services and supplies.

Medicare Part C (Medicare Advantage)

Medicare Advantage plans, Medicare Part C, provide the benefits of Parts A and B and also include Part D (prescription drug coverage). These plans may have additional coverage, such as vision, hearing and dental care.

With a Medicare Advantage plan you continue to pay your Part B premium, and there may be a separate premium you pay to the insurer. However, many Medicare Advantage plans feature $0 monthly premiums. Deductibles and coinsurance charges vary by plan.

Medicare Part D (prescription drugs)

Medicare Part D pays for prescription drugs, both generic and brand name. Plans are offered by private insurers and require a monthly premium. Some Medicare Advantage plans include Part D coverage.

What original Medicare doesn’t pay for

• Opticians and eye exams – Original Medicare does cover ophthalmologic expenses like cataract surgery but not routine eye exams, glasses or contact lenses. Some Medicare Advantage plans cover routine vision care and glasses.

• Hearing aids – Medicare covers ear-related medical conditions, but not routine hearing tests or hearing aids. Some Medicare Advantage plans offer hearing coverage.

• Dental work – Original Medicare does not cover routine checkups or big-ticket items like dentures and root canals. Some Medicare Advantage plans offer dental coverage. 

• International care – Original Medicare and most Medicare Advantage plans don’t cover medical costs incurred outside the U.S.  

• Podiatry – Routine medical care for feet, such as callus removal, is not covered. However, Part B does cover foot exams or treatment related to nerve damage caused by diabetes, plus care for foot ailments like hammertoe, bunion deformities and heel spurs.

• Cosmetic surgery – Medicare only covers plastic surgery that’s needed due to an accidental injury. It doesn’t generally cover elective cosmetic surgery, such as face-lifts or tummy tucks.

• Nursing home care – Medicare pays for limited stays in skilled nursing facilities for recovery and rehabilitation; however, Medicare does not provide coverage if you need to move to nursing facility for the long-term nor does it cover the cost of an assisted living facility due to sickness or frailty.
• Home care – Medicare will pay for a limited amount of skilled home health services such as wound care and physical therapy, but it will not cover the cost of a caregiver to assist you with activities of daily living at home such as bathing, transportation or meal preparation.

Finding out what’s covered

If you have original Medicare only and need to check on coverage and costs, we suggest you try the following sources.

1. Talk to your doctor or other health care provider about why you need the service and ask whether he or she thinks Medicare will cover it. Your doctor or provider knows more than anyone about your individual medical needs.
2. Check your “Medicare & You” handbook that’s mailed to you each fall. 
3. Call 1-800-MEDICARE to see if they have information on any related local or national coverage policies.

If you have Medicare Part C (a Medicare Advantage Plan), contact your insurer.

For additional information on estimated  costs, read this from the Center for Medicare & Medicaid Services. AARP is another good source of Medicare information.

LiveWell by Blakeford

LiveWell members (healthy, independent adults, 60 and older) enjoy exceptional benefits that allow them to maintain the independence they’ve earned. They enjoy access to a range of services and receive the personal attention they need to retain their cherished autonomy. Services include those not covered by Medicare, like meal preparation, personal care, and light housekeeping.

LiveWell offers a range of plans at different cost and coverage levels to best meet a senior’s future and budget. All plans include an essential package of services to make it possible for someone to be as healthy and independent as possible, at home, for a lifetime. Most plans include services at home and if necessary, in an assisted living or nursing care facility. Contact Livewell by Blakeford for more information.