Original Medicare doesn't cover hearing aids or the hearing tests needed to prescribe and adapt hearing aids. You will pay 100% of the costs associated with the hearing aids. Original Medicare doesn't cover routine physical exams. You'll pay 100% of all cosmetic surgeries that aren't covered.
You will pay for 100% of the massage services. Original Medicare doesn't cover acupuncture services, unless they're for chronic low back pain. You'll pay 100% of the costs if you don't meet the coverage requirements. Tinnitus and Hearing Loss Counseling Is a 55+ community right for you? In addition, over-the-counter hearing aids are now available for people with mild to moderate hearing loss.
Medicare beneficiaries who have had low back pain for 12 weeks or longer can now receive up to 20 acupuncture treatments per year. The “exclusive” option eliminates the duplication of payment for these items, since you only pay once to provide the service. While not required, the ABN provides an opportunity to let the patient know that Medicare does not cover the service and that the patient will be responsible for paying for it. Medicare Part B (health insurance) helps cover the cost of medically necessary durable medical equipment if a doctor prescribes it for use at home.
It also doesn't cover help for what are called “activities of daily living,” such as bathing, dressing, going to the bathroom, eating, or moving from one place to another in the house. Medicare Part A (also known as hospital insurance) can generally cover inpatient hospital care, nursing facility care, nursing home care, palliative care, and home health care. In all cases, if the patient's policy coverage isn't clear, tell the patient that they may be responsible for paying for the service. Examples include pre-operative and post-operative care when a surgery is billed or billing for multiple laboratory procedures when a single panel test represents the service provided.
For example, the patient wants the service more often than Medicare allows or to receive a diagnosis that Medicare doesn't cover. If you qualify, Medicaid, which is administered by states according to federal guidelines, can cover care in a nursing home. For example, Medicare doesn't cover breast augmentation for cosmetic reasons, but it does cover reconstructive surgery after a mastectomy. For example, in the case of a medical consultation needed at the same time as a preventive medicine consultation, you can bill for the uncovered preventive visit (excluded), but you must subtract the charge for the covered service from the charge for the service not covered.
When Medicare or another payer designates a service as “combined”, it does not pay separately for parts of the combined service and does not allow the patient to bill for it, since the payer believes that the payment is already included in the payment for another service that it does cover.
