Health insurance benefits are the basis of modern healthcare. Every individual wants to get the best possible health insurance coverage for the most cost-effective price they can.
And this factor has led to the availability of various types of health insurance policies – all with their benefits and peculiarities. Even though, most times, individuals would have to pay for these services, the benefits are always worth it.
However, not everyone can afford healthcare insurance policies, especially those that are more susceptible or have certain issues that may serve as limitations. Depending on your limitations, you could access more subsidized plans that offer cheaper policies at affordable rates and with quality health insurance services.
As of 2022, one of the most common and effective health insurance programs available in the United States is the Medicare health insurance program. This program is tailored towards achieving health accessibility to individuals that originally had difficulties getting suitable healthcare insurance plans to rely on for health coverage.
Based on the Affordable Care Act, Medicare is available to US citizens that are above 65 years of age or have a form of disability or other. These individuals who are mostly more susceptible to Medicare coverage have access to quality healthcare services.
These services might differ from health insurance company to health insurance company. Also, based on the fact that different health conditions would require different services, individual differences would play a major part in determining the type of health services we receive.
Medicare Covered Services 2022
As of 2022, Medicare covers a wide range of health insurance services, all of which depend on a lot of factors. These services are, however, limited and operated within a narrow range of what Medicare would call necessary or medically required.
Medicare does not cover any health services that are not aimed at improving the health of an individual directly. Hence, Medicare would never pay for health expenses that are aesthetic or not necessary based on their context.
Originally, there were two basic Medicare plans -the Original Medicare Plan, which includes Medicare Part A and Medicare Part B; each of which covers a certain aspect of health insurance.
For instance, Medicare Part A covers inpatient expenses for individuals that are admitted to hospitals or those that receive inpatient treatments. Then, Medicare Part B, although very similar to Medicare Part A, covers outpatient expenses mostly.
Other plans like the Medicare Supplement plan and the Medicare Advantage plan serve as Supplemental Plans to help individuals get the most out of their Original Medicare plan since sometimes, the Original Medicare plan coverage is not enough.
You could also get a better prescription by using the Medicare Part D plan. These plans generally offer better coverage alternatives making it easier for individuals to make the most out of their Original Medicare plan.
The specific services that are covered by these health insurance plans often determine the quality of services we receive. Oftentimes, individuals ask questions like “Does Medicare offer dental services?” or “Would Medicare cover my vision coverage?”
Well, these are very valid questions because Medicare does not cover all those services in detail. Nevertheless, there are certain conditions in which Medicare might offer health insurance coverage for certain services.
Below are some of the popular health services sought in a health insurance plan and how Medicare offers coverage.
● Medicare Vision Services
The main aim of Medicare health insurance coverage is to improve the healthcare of those that although they have health issues, are unable to access quality healthcare. Hence, Medicare only covers health insurance plans that are seen as medically necessary.
With regards to eye health and vision services, Medicare does not offer health insurance coverage for routine or basic eye services like routine eye checkups, eye refractions for contact lenses and eyeglasses, etc.
However, for services that greatly affect the health and well-being of the individual, like complex eye surgeries, the medical expenses would be covered by the Medicare coverage plan. Individuals with chronic or severe conditions like cataracts, glaucoma, and so many other rare eye diseases will have their bills covered by medicare.
Medicare would cover the cost of providing prescribed glasses for an individual with a chronic eye condition or one that has just undergone major eye surgery and was prescribed glasses by a physician.
Medicare would also cover the cost of exams aimed at diagnosing a chronic condition, anything medically necessary and particularly instrumental to the advancement of a person’s health.
Although Medicare does not cover routine care normally there are certain conditions in which Medicare would cover your eye check.
Some of these conditions include;
- If you are an African American above 50 years
- If you have a family history of glaucoma
- If you are a Hispanic American above 65 years
- If you are at risk for glaucoma
- If you are diabetic.
● Medicare Dental Services
Dental services like routine checkups, fillings, cleanings, tooth extractions, dentures, etc are often not covered by Medicare. If you need these services, you’d most likely have to pay for your expenses yourself, except of course, you have a Medicare Advantage plan that offers dental coverage.
You could also get alternative dental coverage from an entirely different normal health insurance plan that isn’t affiliated with Medicare. Regardless, Medicare will not pay for the services above because they are mostly basic and can sometimes be classified as aesthetic.
Although Medicare will not offer health insurance services for the services above, there are certain conditions and services that Medicare will offer dental coverage.
Now, this coverage would still be very limited, but Medicare offers dental coverage for services that greatly affect the well-being of the individual or in times of emergencies and chronic conditions.
Some of the scenarios in which Medicare can offer dental coverage include:
- Before a heart valve replacement, Medicare would cover the cost of the oral examination.
- Medicare would cover oral exams before a kidney transplant in a hospital.
- Medicare would pay for surgery to treat face and jaw fractures.
- Medicare would cover the expenses of dental services that are required before radiation treatment for certain jaw-related diseases is done.
- Coverage for ridge reconstruction is performed mostly after tumor removal.
- Medicare would pay for wiring and Dental splints done after a major jaw surgery
● Medicare Hearing Services
Basic hearing services, just like dental and vision services, are often regarded as trivial or just basic, and since it is not a life-threatening situation, Medicare does not offer coverage for these services at all or very minimal coverage at most.
Services like regular ear checkups, insertion of hearing aids, and the like are not covered by medicare; hence you’d have to pay from your pocket if you intend to get these services covered.
With the help of Medicare Advantage and Medicare Supplement plans, individuals can get hearing services on their Medicare coverage. Due to the effect of untreated ear issues, Medicare now offers very minimal coverage in one of the following conditions.
- Medicare will offer coverage for complex ear surgeries, especially those threatening the person’s overall hearing.
● Medicare Transportation Services
One very important aspect of healthcare generally is transportation. First, you need to have access to quality healthcare and the specific services that you need, but if your physician is not visiting your accommodation, you’d no doubt have to move to the hospital.
Normally, transportation shouldn’t be much of an issue, but when the person being transported is a sick person, it becomes delicate; you want to move as carefully as possible with the highest possible speed.
Sometimes, emergencies occur, and the patient needs to get to the hospital as fast as possible. A good transportation source is priceless because there are cases where patients have accidents on their way to the hospital.
In this regard, the Medicare Part B plan makes it possible for individuals to access emergency ambulance services as well as a very limited non-emergency ambulance service which most do not even qualify for. Where the patient’s life is threatened, and there’s no suitable means to convey him or her to the hospital, the Medicare emergency ambulance services come to the rescue.
● Medicare Nutrition Therapy Services
Sometimes diseases cannot be curtailed by drugs alone cause they are linked to a specific type of nutrition, either a deficiency or an overnutrition; either way, drugs would only quell the symptoms if the disease is not tackled by dieting, it’d just be recycled and reoccur again.
Instead of this, healthcare practitioners have been very intentional over the years in nutritional therapy. With this healthcare routine, individuals ‘ health is monitored by feeding.
This service is quite expensive, and so some individuals cannot even afford it. However, recipients of Medicare insurance policies can access this service through the original Medicare Part B plan. However, not everyone can access this service; in fact, normally you shouldn’t access it because Medicare only funds medically necessary medical services.
You could be eligible for this service via Medicare if you’ve had a kidney transplant in about 37 months or if you have kidney stones or diabetes. Either way, Medicare would fund your physical therapy if you’re a recipient and it is medically necessary.
Services that are covered by Medicare Part A
Medicare Part A is an Original Medicare plan mostly known for providing health insurance coverage for inpatient care. Below are the top services that Medicare Part A covers.
- Medicare Part A plan offers health insurance coverage for most Inpatient hospital care.
- Access to Skilled Nursing Facility (SNF) care which might include services like tube feeding, administration of medications, injury care, etc.
- Up to 100 days of Home health care if you need skilled care and you’re homebound.
- Medicare recipients that are terminally ill will have access to Hospice care
It is worth taking note that Medicare does not cover the entire portion of medical expenses as the individual will have to cover a very small portion themselves in the form of deductibles, coinsurance, copayments, and other out-of-pocket expenses.
Services that are covered by Medicare Part B
Similar to the Medicare Part A plan, this Part B plan is an original medicare plan that is known for its outpatient coverage. Below are some of the services that can be enjoyed via this Medicare plan.
- Outpatient medical services.
- Home help services for individuals that are bedridden and need home care.
- Provision of Durable medical equipment for patients.
- Emergency ambulance services are available through this plan.
- Mental illness-related services.
- Performing X-rays and medical tests.
- Access to chiropractic care.
- Drug prescription coverage for specific illnesses and drugs.
Frequently Asked Questions
Does Medicare cover home cleaning services?
Medicare Advantage plans will be able to include more services as of 2019. While Medicare would not pay to have your entire house cleaned, if you have a disease like asthma, Medicare Advantage plans might pay for some particular housekeeping services.
These can involve carpet washing and home air purifiers to lessen lung allergens. Support for family caregivers, non-medical transportation, and adult day care programs could be some of the new Medicare Advantage possibilities.
When they are medically essential, and you meet certain requirements, Medicare may pay for a limited number of home health services.
You should be aware of what Medicare Part A and Part B, which are the Original Medicare plans, cover if you require home healthcare services other than housekeeping services. This would apply, for instance, if you had just left the hospital after med
What services are covered by Medicare Part A?
Services like lab testing, surgery, hospice, inpatient hospital care, skilled nursing facilities, and home health care are all covered under a Medicare Part A hospital insurance plan.
What services are covered by Medicare Part B?
Medicare Part B assists in covering services that are required for medical necessity, such as doctor visits and testing, outpatient treatment, home health care, durable medical equipment, and other medical services. Preventive services are covered in your Medicare Part B plan as well.