As a Medicare beneficiary, you are probably familiar with a lot of what Medicare covers. But there are some less obvious, often-overlooked benefits that could be beneficial to your health and wellbeing.
In some cases, coverage and out-of-pocket costs for these benefits differ depending on whether you have Original Medicare or a Medicare Advantage plan. Medicare Advantage plans must offer the same coverage as Original Medicare, but many offer additional benefits beyond Original Medicare.
These preventive services are covered in full and not subject to any out-of-pocket costs, regardless of whether you have Original Medicare or a Medicare Advantage plan.
- Screenings for Disease – Screenings can lead to earlier detection of diseases, which often means better outcomes. Medicare includes screenings for diabetes, glaucoma, Hepatitis C, breast, cervical, colon, and prostate cancer, and heart disease.
- Mental Health Depression Screening – This benefit covers one depression screening per year. A primary care doctor who can provide follow-up treatment and referrals must carry out the screening.
Inpatient and outpatient mental health treatment, such as counseling, therapy, and medications, is covered under your regular benefits and is subject to deductibles, coinsurance, and copays.
- Smoking Cessation – This benefit covers eight counseling sessions each year to help smokers quit. Individuals with a history of tobacco use who meet the criteria are also covered in full for a preventive yearly lung cancer screening.
Any prescribed medications that help smokers to quit are covered under Part D prescription coverage. Original Medicare does not cover over-the-counter products, such as patches and nicotine gum. If you have a Medicare Advantage, it might offer some coverage or discounts for these items.
- Nutrition Therapy Services – This benefit is for those with qualifying conditions, such as diabetes and kidney disease. Medicare will cover a nutrition and lifestyle assessment as well as the costs of working with a registered dietitian to create a healthy nutrition plan.
- Substance Abuse Treatment – Medicare will cover an Alcohol Misuse Screening and up to four face-to-face counseling sessions with a primary care doctor each year.
Your regular benefits cover inpatient and outpatient treatment for alcohol and substance abuse. This is subject to deductibles, coinsurance, and copays.
These benefits are not considered preventive and are covered under your regular benefits. They may be subject to deductibles, coinsurance, and copays. Your coverage may differ depending on whether you have Original Medicare or a Medicare Advantage plan.
- Diabetic Footwear – Medicare coverage for therapeutic shoes is limited to people with diabetes and severe diabetic foot disease. It covers the fitting and purchase of either one pair of custom-molded orthopedic shoes and inserts or one pair of extra-depth orthopedic shoes each year. Original Medicare does not cover regular shoe orthotics, but if you have a Medicare Advantage plan, you may have some coverage under your Durable Medical Equipment benefit.
- Meal Delivery – Original Medicare only covers meals provided during an inpatient stay at a hospital or skilled nursing facility. Some Medicare Advantage plans cover home delivered meals for a specific period of time while the person is recovering at home after an inpatient stay.
- Transportation – Original Medicare covers medically-necessary rides in some circumstances, such as a ride to dialysis for a patient with end-state kidney disease. Some Medicare Advantage plans cover a specified number of rides through ridesharing services to routine medical appointments and to pharmacies to pick up medication.
- Acupuncture – Original Medicare only covers acupuncture for chronic low back pain, which is defined as pain lasting 12 weeks or longer, not associated with pregnancy or surgery and having no known cause such as cancer, inflammation, or infectious disease. You are covered for up to 12 acupuncture visits in 90 days. Medicare will cover eight additional sessions if you experience an improvement. If you have a Medicare Advantage plan, you might have coverage for additional acupuncture treatment.
- Over-the-Counter Benefits – Some Medicare Advantage plans offer OTC benefits. Beneficiaries receive a monthly or quarterly allowance to purchase everyday items, such as aspirin, toothpaste, bandages, and non-perishable food. Some plans require the use of mail order through a catalog, whereas others allow you to use the benefit at specific stores. Allowances with some plans can be as much as $100 per quarter. Leaving this benefit unused is leaving money on the table.
As with any medical care, it’s important to make sure your healthcare provider participates with your insurance. For Original Medicare, doctors must “accept assignment,” which means they are enrolled as a Medicare provider and agree to accept Medicare’s approved amount as full payment. With a Medicare Advantage plan, your doctor must be in the plan’s network.
Understanding Your Coverage
Regardless of whether you have Original Medicare or a Medicare Advantage plan, you are paying for your healthcare coverage through premiums, deductibles, coinsurance, or copays. Taking the time to understand all the benefits available to you under your plan will allow you to maximize your medical benefits.
For questions about your coverage, Medicare Educators Medicare Educators is here to help.