Navigating Medicare: What is Covered by Your Plan?

  • July 3, 2013
Navigating Medicare: What is Covered by Your Plan?

Medicare is government-subsidized health insurance for individuals over 65, as well as those with specific medical conditions. According to a recent AARP article, 57 million people nationwide rely on Medicare to cover things like doctor visits, hospitalizations and even prescription medications. And although it was established more than 50 years ago in 1965, there’s still much debate over what exactly Medicare should cover.

But before we dive into whether services like home health care and medical alert systems are currently covered by Medicare, it’s important to understand the basics of how this program is organized.

Breaking Down Medicare

When looking at Medicare as a whole, it can seem daunting. But when you break it down into its four large parts, it’s much easier to understand what exactly is covered by each:

  • PART A: This portion of Medicare is hospital insurance, intended to help cover inpatient hospital care. Part A sometimes also helps cover hospice, home health care, and skilled nursing facilities.
  • PART B: This portion of Medicare is medical insurance, for those who qualify for Part A Medicare – helping to pay for doctor’s visits, outpatient care, limited preventative services, and some home health care. Part B requires the payment of a monthly premium.
  • PART C: Known as the Medicare Advantage Plan, Part C allows qualified individuals to receive their Medicare benefits through approved private health insurance companies. This usually gives participants more health coverage options, sometimes including some prescription drug coverage. Additional premiums are often needed for this plan.
  • PART D: The newest part of Medicare is Part D, which is for prescription drugs. Those opting to use Part D pay a monthly premium.

Knowing what is covered by Medicare is only the first step, however, especially since Medicare does not cover all of the costs related to health management. More often than not, it only covers a limited portion of the costs or no portion at all.

What Is Not Covered?

Unfortunately, there are many gaps in Medicare coverage. The cost of health care is already astronomical and rapidly growing. For seniors who are on a limited monthly income, the gaps in Medicare coverage are enough to cause significant financial stress, especially since it does not cover any of the following services:

  • Treatment not medically necessary; i.e. – elective surgery, cosmetic surgery, almost all forms of alternative medicine
  • Vaccinations and immunizations – exceptions are the flu shot and a doctor-prescribed pneumonia vaccine
  • General dental work, including oral surgeries and required medications
  • Eye exams and eye glasses
  • Hearing exams and hearing aids
  • Long-term home care
  • Assisted living facilities
  • Prescription drugs – unless you pay to participate in Medicare Part D
  • Non-prescription drugs and vitamins

Medicare can help cover some of the costs of health care for older adults, but the coverage is not complete enough to protect seniors. Medigap insurance, a Medicare supplemental insurance, can be purchased and will help fill in the gaps in coverage.

While Medigap will certainly help, there’s still numerous beneficial services for older adults that are not definitively covered by Medicare, and unfortunately, personal emergency response systems are part of that list.

Looking for Medical Alert Systems Covered by Medicare

Although this may seem like a easy task, there are very few personal emergency response systems covered by Medicare. While Part B covers different kinds of durable medical equipment, medical alert systems are not included in that category. Certain Medicare Part C plans and other private Medicare insurance plans may cover the cost of medical alert systems, but that’s not guaranteed, either.

Luckily, there are steps you can take that will help you purchase a medical alert system without putting a dent in your wallet:

  • Find an affordable and reliable medical alert company. Even if personal emergency response systems are not covered by your Medicare plan, they can still be affordable if you find the right company. Medical Guardian’s medical alert systems, for example, are designed to fit any lifestyle and budget as prices start at less than $1/day. Plus, we also offer a price-lock guarantee with all of our products, and you will never have to pay activation, installation or equipment fees that other companies commonly charge.
  • Speak with your insurance provider. Once you find a medical alert service, we recommend speaking with your provider to know for sure whether or not your medical alert system is covered by Medicare. Medicare can be complicated to work with, so it’s best to speak with an experienced guide who will help you. Your insurance provider will also be able to help you determine if there’s a possibility to get reimbursed for the cost of the system. Most insurance companies require a doctor’s recommendation before a reimbursement is made.
  • Check for senior assistance programs. It’s normal to feel discouraged after your find out that your Medicare plan does not cover your personal emergency response system, but be sure to check with the Department of Aging Services, your local Department of Human Resources and any other senior assistance programs in your state or community. These programs are specifically designed to help you cover different costs, including the cost of medical alert systems.
  • Reduce your fall risk. Even though the Centers for Disease Control and Prevention estimate that 1 in 4 older adults falls every year, you don’t have to become part of that statistic. In fact, there are many simple, preventative steps you can take that will lower your risk of experiencing a fall and avoid paying the steep financial cost of falls.

Getting Involved in Your Healthcare

Though it exists to help the aging American population, Medicare is not the answer to all healthcare concerns for seniors. Review your policy and make sure that you have enough coverage to protect yourself and your family.

ABOUT THE AUTHOR: Medical Guardian is a leading provider of innovative medical alert systems that empower people to live a life without limits.

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