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Medicare Doesn’t Cover WHAT?!

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Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP) and trained Medicare Counselor, whose work focuses on helping aging adults and folks with limited independence by providing resources and support to help them discover and lead their best life. Gregory has been a key member of the CCM team for over a decade. – Charlotte

This is the second installment in a three-part series to help clear up some common misconceptions about Medicare. Medicare isn’t intentionally confusing, but with all the cross-talk surrounding Medicare, even if understanding it isn’t as intuitive as “1,2,3”, it’s at least as easy as “A, B, D.”

In the last post, I discussed the structure of Medicare, and its division into two main parts (A & B) and a supplemental part (D). In review, the major portions of the program look like this:

  • Part A – “Original Medicare”, covers in-patient stays (including hospital stays, or stays in rehab facilities, etc.)
  • Part B – “Original Medicare”, covers physician visits (including Primary Care Provider visits, or referrals)
  • Part D – added under the Medicare Modernization Act of 2003, covers select prescription drugs.

Let me start with some of Medicare’s surprising omissions of coverage.

Again, the way the public thinks that the service works and how the service functions in practice are not the same. For example, Part A is designed for stays in medical facilities, but not all stays, and not all facilities are covered. The same can be said for Part B, which does not cover all physician office visits. How does this work?

While most traditional, scheduled physician visits are covered, you shouldn’t expect to be covered by Medicare Part B for:

  • Most dental care
  • Eye exams related to prescribing glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care

Which facility stays are not covered under Medicare Part A?:

  • Long-term care
  • “Custodial” care

It may come as a shock to many, but Medicare does not pay any part of the cost for permanent residence in a Skilled Nursing Facility (commonly called a Nursing Home). Without long-term care insurance, many aging adults find themselves unsure how to manage to pay for extended, custodial care.

Next week, we’ll talk about options to close the “gaps” in coverage and how folks covered by Medicare are planning for themselves with the help of Medicare Counselors.

Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago.  She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.

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