Medicare may not cover your service for a variety of reasons – it may be that you do not have the type of Medicare plan required to cover a certain treatment, it could be a service Medicare doesn’t cover, or be because you’re seeing a physician who doesn’t accept Medicare. In any situation, you have options.
What Services Doesn’t Medicare Cover?
This depends on the type of Medicare policy you hold. To get the most complete coverage, you will need to purchase inpatient (Part A), outpatient (Part B), and prescription coverage (Part D). Or, you may opt to get Medicare Advantage (Part C), which is a combination of inpatient and outpatient coverage – some even include drug coverage along with that.
Part A and Part B together make up Original Medicare. This is nationwide with no network, so your coverage will apply at any U.S. medical facility that accepts Medicare. They won’t cover prescriptions since that is Part D’s role. But as for procedures related to their coverage, they will not cover routine dental, vision, and hearing services.
If you want to get dental, vision, and hearing coverage, you will either need to switch to a plan that covers those items, such as Medicare Advantage, or pay all costs out-of-pocket.
If your Part D plan doesn’t cover a certain medication, your plan will work to find you a similar medication or a generic version of what you’re prescribed. You would only pay all costs for medications if you insisted on keeping a medication your plan doesn’t cover.
What If I Have A Medicare Advantage Plan And Get Treatment Out-of-Network?
Most Medicare Advantage policies have networks, requiring you to get treatments from specific healthcare providers within a given area. If you go out-of-network, you will either pay slightly more or all costs, even if that out-of-network provider accepts Medicare.
But you won’t have to worry about network restrictions if you have an emergency. Medicare Advantage plans will cover out-of-network emergency services.
What If My Physician Doesn’t Accept Medicare?
Some physicians don’t accept Medicare for various reasons. However, some may be willing to accept Medicare assignment with the condition that they can charge extra fees. Here, you would pay the difference between Medicare’s coverage and the doctor’s extra fees.
If your doctor won’t accept Medicare under any circumstances, you’ll either have to switch to one who does, or bear the full costs.
If your doctor no longer accepts Medicare, you’ll get a notice so you will know in advance. This will give you an opportunity to find another doctor who accepts your plan.
Save More On Out-Of-Pocket Expenses Today
At Medicare With Jake, we’ll work with you to help you get the coverage you need for the lowest cost. Call us today at (833) NOW-JAKE to learn more.
