Original Medicare (parts A and B) doesn't cover all health care services, including vision, hearing and dental care. However, Medicare Advantage (Part C) plans may offer coverage for some of these services. Hospital insurance (Part A) helps pay for hospital care in a temporary hospital or skilled nursing facility (after a qualifying hospital stay), a portion of minimum home health care (after a qualifying hospital stay), and palliative care (as long as your doctor has given you less than 6 months to live). Health insurance (Part B) helps pay for the services of doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services. Medicare Advantage (Part C) plans are available in many areas.
People who have Medicare Part C choose to receive all of their health care services through a single HMO provider. Prescription drug coverage (Part D) helps pay for prescription drug costs. Medicare Part B (health insurance) helps cover the cost of medically necessary durable medical equipment if a doctor prescribes it for use at home. Paying for home care requires planning ahead (article on paying for care). As you can see, Medicare doesn't cover everything.
For example, Medicare doesn't cover breast augmentation for cosmetic reasons, but it does cover reconstructive surgery after a mastectomy. When Medicare or another payer designates a service as “combined”, it does not pay separately for parts of the combined service or allow the patient to bill it, since the payer believes that the payment is already included in the payment for another service that it does cover. For example, the patient wants to receive the service more often than Medicare allows or to receive a diagnosis that Medicare doesn't cover. 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.
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.
