Author: Carmelo DeFranco
Date: 09/27/2022
Reading Time: 4 minutes

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Medicare is a federal program primarily serving seniors, young disabled people, and dialysis patients. Patients pay some costs through hospital deductibles and other expenses to make the program sustainable. Typically, most people become eligible for Medicare 3 months before turning 65. Before turning 65, you might have another form of insurance, such as COBRA or retiree health insurance. Be that as it may, once you turn 65, Medicare becomes the primary insurer automatically. This means other insurance policies are considered secondary even if you haven't applied for Medicare.

With more than 55 million Americans relying on the Medicare program, understanding how the program works is crucial. Ideally, seniors' health care can be complex and demanding with regular medications, hospital stays, therapies, and medical procedures. After enrolling in Medicare, it is essential to understand what Medicare health plans may cover. Here are 5 things Medicare health plan can pay for:

1. Home Health Care

Seniors with underlying medical conditions prefer home health care to live safely and comfortably. However, most people assume they cannot qualify for Medicare-covered home health insurance. That's not the case because there are numerous home healthcare service options to choose from, depending on your healthcare needs. Currently, Medicare has a home health care benefit to help seniors access cost-effective and reliable care outside hospitals and nursing homes. Luckily, the home healthcare benefit does not come with a co-pay. Ergo, most seniors can access reliable medical services at an affordable cost. With Medicare home healthcare benefits, it is not a must to have a hospital stay to qualify! Some people assume that if they have not been in a hospital, Medicare cannot cover their home care needs! That's not the case. However, they need a doctor's declaration showing that they have a medical condition requiring home health care.

2. Wellness Care Visits

Although one can retire after turning 65, some seniors prefer to continue working. Besides having a regular paycheck, seniors interact with their colleagues and other people in their places of work. However, routine wellness care visits are required as they age to ensure everything is in order. With Medicare, seniors have a free wellness care visit per year. This means that seniors can get a free medical examination to ensure they are healthy yearly. Preventive care is crucial to guarantee everything is okay. If you smoke and want to quit, you can undergo smoking cessation counseling for free. Taking care of yourself is the only way to guarantee you are alright and continue working.

3. Medical Equipment

Buying medical equipment is very costly. However, seniors can purchase durable medical equipment (DME) with Medicare Part B. Medical Part B's equipment includes hospital beds, wheelchairs, oxygen tanks, walkers, canes, blood glucose monitors, and crutches. It is important to note that Medicare covers only 80% of the approved cost after the beneficiary has met the Medicare Part B deductible. Luckily, Medicare partially covers the cost of buying Continuous Positive Airway Pressure (CPAP) equipment. The CPAP equipment is used to treat obstructive sleep apnea. To help seniors sleep better and breathe, the machine uses a hose connected to a mask to deliver constant and balanced air pressure.

4. Prosthetics

Prosthetics help a part of the body that is damaged, stopped working, or is removed. Medicare Part B covers any prosthetic devices if they are considered medically necessary, i.e., if a Medicare-enrolled doctor or other healthcare providers order them. Prosthetics are covered as durable medical equipment (DME); most of the time, the cost is almost entirely covered. Examples of prosthetics covered by Medicare include

Remember, if you choose Medicare Advantage Plan (Medicare Part C) instead of Medicare Part A and B, your plan should cover prosthetics. Ideally, Medicare Advantage Plan offers coverage just like Medicare, with some offering additional coverage. However, it is essential to confirm what's covered and how much you will have to pay for prosthetics. The doctor or healthcare provider ordering your prosthetic must:

5. Chiropractic Care and Physical Therapy

Medicare covers chiropractic procedures, specifically to treat a condition known as spinal subluxation. You need an official diagnosis and a qualified chiropractor to benefit from this coverage. It is crucial to understand that Medicare covers care to correct an existing problem, not spinal manipulations, as preventive or maintenance services. Also, Medicare does not cover X-rays and massage therapy. Therefore, if a chiropractor recommends or offers these services, it is prudent to inquire about the cost of each because you will pay out of pocket. Be that as it may, Medicare pays for a physician to perform an X-ray. Medicare Part B covers physical therapy treatment recommended by a doctor to treat back pain. However, you must pay 20% of the approved amount up to your deductible for physical therapy treatment.

Although Medicare covers healthcare, it does not cover long-term care. Therefore, if you were hospitalized, Medicare covers home healthcare or skilled nursing facility costs, not custodial care. Custodial care helps you manage your daily living, for example, bathing and clothing. For custodial care, you must rely on long-term insurance care, savings, or Medicaid if you meet the necessary requirements. Also, Medicare does not cover routine eye or dental care and devices like hearing aids and dentures.

Finally, you can file an appeal if you disagree with the Medicare payment decision or coverage. The Medicare appeal process has five levels. If your appeal is denied, you can advance to the next level. It is essential to gather crucial information from your supplier, doctor, or healthcare provider to win an appeal. Remember, if you cannot wait for a decision due to health problems, you can request an escalation of the appeal if the Medicare plan or doctor agrees. With an escalation of the appeal, you can get a decision within three days.

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