What Does Medicare Part A&B Not Cover?

Unfortunately, Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance that covers these services.

Even if Medicare covers a service or item, you will have to pay your deductibles, coinsurance, and or copayments.

Some of the items and services that Medicare doesn’t cover include:

  • Long Term Care
  • Routine Eye Exam (vision exam or exam related to prescribing glasses)
  • Dental
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

    Routine eye exam not covered by Medicare

    Routine Eye Exam is NOT Covered Under Medicare

What’s The Difference Between a Doctor “Accepting Medicare” or accepting “Medicare Assignment”?

It’s important to know that not all doctors bill the same way. Some doctors accept “Medicare Assignment” and agree to the rates Medicare sets and takes those amounts as full payment. Other doctors participate in the Medicare program but do not accept Medicare Assignment.

Accepting Medicare Assignment

Doctors who accept Medicare Assignment agree to be paid by Medicare. They submit the claim to Medicare and agree to accept the Medicare-approved dollar amount for a procedure. They can’t charge you more than that amount. You will still be responsible for dedcuctibles, co-pays and coinsurance (often 20%), but your share is limited by what Medicare pays.

Not Accepting Assignment

Some doctors participate in the Medicare program but do not agree to accept Medicare Assignment. Under the rules of Medicare Part B, doctors are allowed to charge you a an additional 15%, on top of the 20% you are already responsible for, if they accept Medicare, but not Medicare Assignment.  These are referred to as “excess charges”.  So in reality, you would be responsible for 35% of the bill, instead of 20%.  When looking at Medicare Supplements, be sure to check if your plan will pay these “Excess Charges” or not.

The best way to find out whether or not your doctor accepts Medicare Assignment is to call the doctor’s office directly.. Continue reading

Paying for Medicare Out-of-Pocket Expenses

Medicare beneficiaries need to pay a significant portion of their health care costs. Medicare requires beneficiaries to pay premiums, deductibles and coinsurance. But there’s a lot you can do to keep these costs manageable. Here are some steps to minimize Medicare’s out-of-pocket costs.

 

Premiums: Most people aren’t charged a premium for Medicare Part A hospital insurance. The standard monthly premium for Medicare Part B medical insurance is $104.90 in 2015. This amount is typically deducted from your Social Security check if you are already receiving payments, but those who have not yet claimed Social Security will receive a bill. People with adjusted gross incomes above $85,000 for individuals and $170,000 for couples are charged higher Part B premiums.

 

It’s important to sign up for Medicare Part B during the initial enrollment period, which is a seven-month window that begins three months before your 65th birthday. Your Part B premiums will increase by 10 percent for each 12-month period you were eligible for Medicare Part B but didn’t sign up for it. If you are 68 when you sign up for Medicare Part B, you will be hit with a 30 percent premium increase every year for the rest of your life, If you didn’t sign up for Medicare Part B at age 65 due to participating in group health insurance through your job, you should sign up within eight months of leaving the job or the coverage ending to avoid the penalty.

 

Deductibles and coinsurance: The Medicare Part B deductible is $147.00 in 2015. Once retirees meet the deductible, they typically need to pay 20 percent of the Medicare negotiated cost for each service. Any time you have any serious medical issues, that 20 percent is going to be a serious amount of money. If the doctor does not accept “Medicare Assignment”, you could also be hit with an additional 15% (Excess Charges), on top of the 20%. There is no annual limit on out-of-pocket costs with Medicare. Medicare Part A has a $1,260.00 deductible (per benefit period) for beneficiaries who are hospitalized.

 

Supplemental insurance: Medigap policies are supplemental insurance plans that will pay for the copayments, coinsurance and deductibles of traditional Medicare and sometimes extra services in exchange for an additional premium. “A Medigap policy will cut down your irregular out-of-pocket costs, The Medigap initial enrollment period occurs during the first six months you are 65 or older and enrolled in Medicare Part B. After this period ends, you could be denied the right to purchase a Medigap policy or charged significantly higher premiums based on your medical history.

 

Preventative care: Medicare covers a variety of preventative care services with no cost-sharing requirements, including a free annual wellness visit, flu shots and screenings for a variety of illnesses. Vaccines and preventative exams are fully covered as well as some outpatient stuff. However, conditions discovered during these preventative care visits could require additional tests or treatments that do have an out-of-pocket cost, sometimes even during a visit that you thought would be completely covered. You will be required to pay for it if another procedure is done.

 

Prescription drug coverage: You can sign up for Medicare Part D beginning three months before you turn 65. A late enrollment penalty is added to your Part D premium if you go 63 or more days without prescription drug coverage after age 65. Medicare Part D premiums, deductibles, coinsurance, copays and covered medications vary depending on the plan you choose and change each year, even if you stick with your existing plan. You can switch Medicare Part D plans during the open enrollment period from October 15 to December 7. You are allowed to change plans every year without penalty, and I recommend that people do it. Even if your drugs don’t change, the policies of the plan might change. It’s important to examine how your costs and coverage will change each year, and consider switching if you can find coverage that suits your needs at more affordable prices.

 

Medicare Doesn’t Cover Everything: While Medicare covers many of the services people need, there are a few common medical services that it doesn’t. Medicare won’t pay for eyeglasses, hearing aids or dental care. Most significantly, Medicare doesn’t typically cover extended nursing home stays or other types of long-term care. Things like vision care, eyeglass, hearing aids, dental care and non-prescription drugs, these are all things that Medicare doesn’t cover at all. Those are things that you need to figure out another way to pay for.