Does Medicare Offer Benefits Outside of Doctor Visits and Hospital Stays?
Securing healthcare benefits as an American over the age of 65 is critical. More than 65 million people in the U.S. rely on Medicare benefits, which primarily include hospital and medical coverages through Part A and Part B. Medicare beneficiaries may not know that they also have access to many additional benefits.
These lesser-known Medicare benefits include counseling, hospice and chronic care management, and transportation services. For seniors who require these resources, confirming their eligibility for a wider range of Medicare benefits can greatly improve their quality of life. Discover how to make the most of the benefits you may be missing out on.
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The Top Medicare Benefits You May Be Missing Out On
You may be underusing your Medicare coverage if you haven’t explored these options. Do not sleep on the following little-known Medicare benefits.
1. Alcohol and Nicotine Counseling
Medicare may cover alcohol and nicotine counseling for adults who receive an order from their primary care doctor for an alcohol misuse screening. Ideal candidates for screening are adults (including pregnant women) who use alcohol but are not deemed alcohol-dependent by medical standards.
Medicare covers one alcohol misuse screening per year and, subsequently, up to 4 face-to-face counseling sessions per year. Medicare additionally covers 8 sessions in a 12-month period for tobacco use disorder counseling. As long as your provider accepts Medicare assignment, this service is covered and requires no out-of-pocket costs on your part. Many people are unaware such counseling exists for non-alcohol-dependent cases so they do not seek out these benefits.
2. Obesity Counseling
Medicare beneficiaries with a body mass index (BMI) of 30 or higher can receive an obesity screening and behavioral counseling, covered by Part B benefits. Medicare covers an initial screening and obesity counseling, which includes a personalized dietary assessment and treatment plan. Medicare requires patients to undergo counseling in a primary care setting.
Obesity is a chronic disease affecting adults and seniors on Medicare in the U.S. While nearly 42% of Americans are clinically obese, they may not be aware of the benefits of counseling as a treatment for this condition; however, Medicare requires it as part of a multi-faceted treatment plan.
3. Hospice Care
Medicare covers hospice care, typically including all of the related costs for home or inpatient care and prescription medications. To qualify for benefits, a doctor must certify the patient is terminally ill with a life expectancy of 6 months or less, and the patient must accept palliative care over curative medicine and sign a statement to activate hospice care instead of another Medicare-approved treatment.
Patients living in a nursing facility who choose to go on hospice must still pay for room and board. They may owe 5% of the cost of inpatient respite care, not to exceed their annual inpatient hospital deductible. Though uncommon, patients may need to pay up to $5 for non-approved medications.
4. Footwear for Diabetics
Many people living with diabetes are unaware of the benefits of special footwear for their condition. These medical aides not only exist but are also covered by Medicare. Benefits include specialized shoes, custom inserts, and extra-depth shoes to help increase foot circulation.
Medicare covers the fitting and manufacturing of one pair of custom-molded shoes and inserts or one pair of extra-depth shoes per year for those with diabetes and severe diabetic foot disease. Medicare will also cover the cost of modifying your existing shoes instead of creating new inserts, two additional pairs of custom inserts, or three additional pairs of extra-depth shoe inserts per year. Beneficiaries owe 20% of costs after meeting their Part B deductible.
5. Transportation Services
While outpatient medical care is critical for seniors and other Medicare beneficiaries, they may not know they can also qualify for non-emergency transportation services to help them travel to and from medical appointments in some cases. Recipients are responsible for 20% of non-emergency transportation costs after they meet their Part B deductible.
Part B may cover non-emergency transportation services. In order to qualify for these benefits, your doctor must recommend non-emergency, medically necessary transport for a select treatment or service, such as dialysis for a patient with end-stage renal disease. Medicare Advantage (Part C) plans may offer extended transportation coverage.
6. Wheelchairs and Scooters
Medicare may cover the cost of wheelchairs and scooters for individuals that require mobility assistance to perform daily activities. People suffering from a debilitating disease or disability may mistakenly think they are on their own when it comes to being able to afford such benefits.
Medicare Part B covers wheelchairs and scooters as durable medical equipment (DME) only when deemed medically necessary by a doctor for patients with documented limited mobility. Other criteria for Medicare-approved DME include the inability to perform routine activities such as bathing and dressing, even with a cane or walker, and the ability to operate the DME safely. Patients are responsible for 20% of approved DME costs after meeting the Part B deductible.
7. Chronic Care Management
Medicare’s little-known chronic care management benefits not only provide comfort for Medicare beneficiaries but also help facilitate integrated healthcare practices. People who have or expect to have two or more comorbid chronic health conditions for at least the next year may qualify for benefits.
Medicare requires beneficiaries to pay a monthly fee for chronic care management. The Part B deductible and coinsurance also still apply. Patients must make the first monthly payment and sign off on chronic care services to start treatment, which includes a comprehensive care plan, medication management, and 24/7 urgent care support.