Medicare coverage
Does Medicare Cover Everything? The Costs That Can Catch You by Surprise
Medicare helps pay for many important health services, but it does not cover every expense. Understanding your share of the costs can help you plan before you need care.
The first question is: Do you have Original Medicare or a Medicare Advantage plan? Your answer affects how you receive care and what you pay.
Original Medicare can leave you with out-of-pocket costs
Original Medicare includes Part A and Part B. Even when a service is covered, deductibles and coinsurance may apply.
Original Medicare alone does not have an annual out-of-pocket ceiling for Part A and Part B services. Supplemental coverage, such as Medigap or certain employer coverage, may help pay your share.
A $0 Medicare Advantage premium does not mean $0 health care
Some Medicare Advantage plans have no additional monthly plan premium, but you generally must continue paying your Part B premium. You may also owe copayments, coinsurance, or deductibles.
Medicare Advantage plans have an annual limit on your costs for covered Part A and Part B services. That limit does not mean all health spending is included: premiums, Part D prescription expenses, and noncovered services are separate.
Routine dental, vision, and hearing expenses can be separate
Original Medicare generally does not cover routine dental care, routine eye exams for glasses, or hearing aids and fitting exams. Certain medically necessary services have different coverage rules.
Some Medicare Advantage plans include additional benefits, but you should check their networks, allowances, frequency limits, and your share of the cost.
Long-term personal care is another gap
Medicare generally does not cover long-term custodial care when the main need is help with daily activities, such as dressing or bathing. That is different from qualifying skilled care covered under Medicare’s rules.
What can help with the gaps?
Depending on your situation, options to review may include Medicare Supplement insurance with Original Medicare, prescription drug coverage, or additional coverage for specific needs.
Medigap helps pay certain Original Medicare cost-sharing expenses. It is not designed to pay Medicare Advantage copayments.
Before purchasing additional insurance, identify the expense you want help with. Then compare the policy’s premium, benefits, exclusions, and limits.
Contact Simply Health Insurance Agency at simplyhealthinsurance.net for a coverage review. We can help you understand what your coverage pays, what you may owe, and which options are worth considering.