{"id":355791,"date":"2016-04-04T10:46:14","date_gmt":"2016-04-04T15:46:14","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/healthcare\/medicare-medicaid\/medicare-faqs.html"},"modified":"2025-09-09T10:15:17","modified_gmt":"2025-09-09T15:15:17","slug":"medicare-faqs","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicare-faqs.html","title":{"rendered":"Medicare FAQs"},"content":{"rendered":"\n<div class=\"wp-container-core-columns-is-layout-8f761849 fl-sectionWithSidebar fl-container fl-flex fl-flex-wrap fl-gap30\">\n<div class=\"fl-page-articles fl-section-main fl-section-main-full-width\"><h1 class=\"fl-no-margin-top\">Common Medicare Questions and Answers<\/h1>\n\n<section class=\"fl-gutenberg-byline\">\n    <div class=\"fl-gutenberg-byline-content\">\n                    By <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/lyle-therese-a-hilotin-lee-j-d\/\">Lyle Therese A. Hilotin-Lee, J.D.<\/a> | Legally reviewed by <a\n                href=\"https:\/\/www.findlaw.com\/company\/our-team\/jordan-walker-j-d\/\">Jordan Walker, J.D.<\/a>\n                | Last updated\n        <time>\n                            September 09, 2025\n                    <\/time>\n    <\/div>\n\n    \n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-legally-reviewed\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Legally Reviewed\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>This article has been written and reviewed for legal accuracy, clarity, and style by <a href=\"https:\/\/www.findlaw.com\/company\/our-team.html\">FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with <a href=\"https:\/\/www.findlaw.com\/company\/company-history\/editorial-policy.html\">our editorial standards<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n\n    <details class=\"fl-gutenberg-byline-toggle fl-gutenberg-byline-fast-checked\">\n        <summary>\n            <i class=\"fl-gutenberg-byline-icon\" aria-hidden=\"true\"><\/i>\n            Fact-Checked\n        <\/summary>\n\n        <div class=\"fl-gutenberg-byline-toggle-content\">\n            <p><em>The last updated date refers to the last time this article was reviewed by FindLaw or one of our <a href=\"https:\/\/www.findlaw.com\/company\/our-team\/contributing-authors.html\">contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please <a href=\"https:\/\/lawyers.findlaw.com\/?fli=bylinelink\" target=\"_blank\" rel=\"noopener\">contact an attorney in your area<\/a>.<\/em><\/p>\n\n        <\/div>\n    <\/details>\n<\/section>\n\n\n<div class=\"fl-key-takeaways fl-mb30\" data-testid=\"fl-key-takeaways\">\n    <div class=\"fl-card-content\">\n        <div class=\"fl-card-body fl-card-bg-teal fl-flex fl-flex-column\">\n                            <h2 class=\"fl-card-title fl-h2 fl-no-margin\">Key Takeaways<\/h2>\n                        <p><i data-redactor-tag=\"i\">Whether you&#8217;re\u00a0enrolled in Medicare or trying to figure out which plan is for you, you&#8217;re bound to have questions about the system. It&#8217;s important\u00a0to know\u00a0who&#8217;s eligible, what each part of the federal health insurance program pays for, how\u00a0enrollment requirements work, and\u00a0what it costs. There&#8217;s a lot to learn about\u00a0premiums, deductibles,\u00a0coinsurance, and what may not be\u00a0covered, such as\u00a0long-term care and most dental,\u00a0vision, and\u00a0hearing visits. This article also explains\u00a0Part D drug coverage and costs, referrals for specialists, common pitfalls like missed deadlines and plan mismatches, and where to get help.<\/i><\/p>\n\n        <\/div>\n    <\/div>\n<\/div>\n\n\n<p>Understanding the complex rules and regulations of Medicare coverage is important, but it&#8217;s not always easy. To receive\u00a0the healthcare benefits that you are entitled to under federal law, it helps to know how the system works. If you are facing issues related to Medicare and feel lost, contact a\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/health-health-care-law\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">healthcare attorney<\/a>. They can help you understand your rights and ensure you are receiving the proper Medicare benefits.<\/p>\n<p>This article provides a comprehensive overview of Medicare&#8217;s most frequently asked questions (FAQ).<\/p>\n<h2>What is Medicare and who is eligible?<\/h2>\n<p>Medicare is a medical insurance coverage program that the U.S. government administers to qualified individuals. This program works under the\u00a0<a href=\"https:\/\/www.ssa.gov\/OP_Home\/ssact\/title18\/1800.htm\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Social Security Act<\/a>, and is overseen by the\u00a0<a href=\"https:\/\/www.hhs.gov\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">U.S. Department of Health and Human Services<\/a>. Its purpose is to provide healthcare coverage to people 65 years old and above. Certain individuals under 65 years old with disabilities or illnesses such as\u00a0end-stage renal disease may\u00a0also qualify.<\/p>\n<p>Medicare plans have four parts: A, B, C, and D. Each parts of Medicare covers different portions of healthcare. Here&#8217;s a quick look at what each is responsible for:<\/p>\n<ul>\n<li><strong data-redactor-tag=\"strong\" data-verified=\"redactor\">Part A<\/strong>\u00a0covers overnight hospital stays, including room, food, tests, and doctor&#8217;s fees<\/li>\n<li><strong data-redactor-tag=\"strong\" data-verified=\"redactor\">Part B<\/strong>\u00a0helps pay for some services and products not covered by Part A, such as\u00a0outpatient costs<\/li>\n<li><strong data-redactor-tag=\"strong\" data-verified=\"redactor\">Part C<\/strong>\u00a0plans give those eligible for Medicare the option of receiving their benefits via private health insurance plans<\/li>\n<li><strong data-redactor-tag=\"strong\" data-verified=\"redactor\">Part D<\/strong>\u00a0covers certain prescription medicines<\/li>\n<\/ul>\n<p>While that gives an overview of what each plan covers, knowing more details can make understanding what you need easier. Let&#8217;s take a deeper dive into each plan:<\/p>\n<h2>What is Medicare Part A?<\/h2>\n<p>Medicare Part A is a component of Medicare that helps patients pay for inpatient hospital stays, access to hospitals, and nursing facilities. It also helps cover costs for hospice care and other home health care.<\/p>\n<p>The following is a list what Medicare\u00a0<a href=\"https:\/\/www.medicare.gov\/what-medicare-covers\/part-a\/what-part-a-covers.html\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Part A covers<\/a>:<\/p>\n<ul>\n<li>Overnight hospital stays, including room, tests, meals, general nursing, facility fees, and miscellaneous hospital services and supplies<\/li>\n<li>Critical access hospital stays and mental health care<\/li>\n<li>Reasonably necessary medical in-home services such as skilled nursing care, physical and occupational therapy, speech therapy, and medical social services<\/li>\n<li>Home-use equipment such as wheelchairs, hospital beds, walkers, oxygen, and certain medical supplies<\/li>\n<li>Hospice, if you&#8217;re terminally ill and have six months or less to live<\/li>\n<li>Brief nursing home visits if you were previously required to stay at least three midnights in the hospital, your nursing home stay is due to something diagnosed during that previous stay, you have another issue requiring skilled nursing care, or your nursing home care is skilled care and not merely custodial, non-skilled, or long-term care<\/li>\n<\/ul>\n<p>Medicare Part A also covers a maximum of 100 days of nursing home stay. The first 20 days are paid in full, while the other 80 require a co-payment. The clock for your maximum days covered for inpatient treatments (hospital and nursing home) resets after 60 days of not using facility-based service coverage.<\/p>\n<h2>Am I eligible for Medicare Part A?<\/h2>\n<p>You are eligible for\u00a0Medicare Part A\u00a0if you are at least\u00a065 years old. Most people receive\u00a0this healthcare coverage for free based on their work history or their spouse&#8217;s. You may also need at least 40 credits of Medicare-covered employment in order to qualify for Part A Medicare.<\/p>\n<p>If you do not meet the Medicare eligibility requirements, you can still enroll and\u00a0receive the same coverage by paying a monthly premium. The Medicare premium is\u00a0based on the number of work credits you have accumulated throughout your career.<\/p>\n<h2>What does Medicare Part B cover?<\/h2>\n<p>Medicare Part B covers necessary medical services and\u00a0supplies. This includes\u00a0preventing\u00a0illnesses or detecting the need for\u00a0an early treatment. In addition,\u00a0<a href=\"https:\/\/www.medicare.gov\/providers-services\/original-medicare\/part-b\" target=\"_blank\" rel=\"noopener\">Medicare Part B<\/a>\u00a0also covers:<\/p>\n<ul>\n<li>Doctors&#8217; services at a hospital, a doctors office, or at home<\/li>\n<li>Laboratory tests (100%)<\/li>\n<li>Periodic exams such as mammograms, bone density tests, and pelvic exams for women<\/li>\n<li>Outpatient treatment, such as ER and clinic visits, X-rays, tests, and shots<\/li>\n<li>Medicines given while in the hospital or at your doctor&#8217;s office<\/li>\n<li>Medical equipment and supplies<\/li>\n<li>Some outpatient therapy<\/li>\n<li>Some counseling services<\/li>\n<li>Some preventive services<\/li>\n<li>Some Alzheimer&#8217;s-related care<\/li>\n<\/ul>\n<p>This is not an exhaustive list.<\/p>\n<h2>Am I eligible for Medicare Part B?<\/h2>\n<p>You&#8217;re\u00a0<a href=\"https:\/\/www.cms.gov\/medicare\/enrollment-renewal\/original-part-a-b\" target=\"_blank\" rel=\"noopener\">eligible for Medicare Part B<\/a>\u00a0if you meet at least\u00a0one of the following criteria:<\/p>\n<ul>\n<li>You are at least\u00a065 years old\u00a0and\u00a0are a U.S. citizen<\/li>\n<li>You are\u00a0at least 65 years old\u00a0and\u00a0are a lawful permanent resident who has lived in the United States for five\u00a0continuous years before filing an application for Medicare<\/li>\n<\/ul>\n<p>You do not have to be eligible for Medicare Part A to be eligible for Medicare Part B. However, you will pay monthly premiums for Part B coverage, and the amount may be higher based on your income.<\/p>\n<h2>How much of my bill will Medicare Part B pay?<\/h2>\n<p>When added all together, Medicare\u00a0ends up paying for about half of your total medical expenses. This is due to a few different factors:<\/p>\n<ul>\n<li>You&#8217;ll likely have routine exams, medicines, glasses, hearing aids, dentistry, etc., that\u00a0<a class=\"editor-rtfLink\" href=\"https:\/\/www.medicare.gov\/what-medicare-covers\/not-covered\/item-and-services-not-covered-by-part-a-and-b.html\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Medicare doesn&#8217;t cover<\/a><\/li>\n<li>Medicare decides on its own what the appropriate amounts, or approved charges, are for each of your services<\/li>\n<li>These approved charges are usually far less than what doctors are actually charging, as\u00a0participating providers cannot bill you\u00a0above the Medicare\u2011approved amount.\u00a0<\/li>\n<li>For non\u2011participating providers, a limiting charge applies in most states, and balance billing is restricted<\/li>\n<li>Although several services are fully covered by Medicare Part B, it only pays about 80%\u00a0of the approved charges for other services<\/li>\n<\/ul>\n<p>Federal regulations from the Department of Health and Human Services establish a reimbursement structure. They determine payment rates for medical services across the health system.<\/p>\n<h2>What is Medicare Advantage (Part C) and what does it cover?<\/h2>\n<p><a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicare-managed-care.html\">Medicare Part C<\/a>\u00a0is a private health insurance plan. Anyone who&#8217;s eligible for Parts A and B is also\u00a0eligible for Medicare Advantage. Beneficiaries pay monthly premiums. For some, Medicare Advantage is\u00a0\u00a0a better fit than\u00a0Plan A and Plan B, often\u00a0because of the more complete\u00a0coverage of prescription drugs. Medicare beneficiaries also pay a monthly premium to receive Medicare Part B coverage. The following is a list of benefits that various Plan C plans offer:<\/p>\n<ul>\n<li>Medically necessary services from any hospital or doctor in the country<\/li>\n<li>Prescription drugs<\/li>\n<li>Dental care<\/li>\n<li>Vision care<\/li>\n<li>Gym and health care memberships<\/li>\n<\/ul>\n<p>Medicare Advantage offers more flexibility and coverage than other Medicare plans, but at a cost.<\/p>\n<h2>Who is\u00a0eligible for Medicare Part D coverage?<\/h2>\n<p>You&#8217;re eligible for\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/choosing-a-medicare-part-d-plan.html\">Medicare Part D<\/a>\u00a0coverage if you&#8217;re:<\/p>\n<ul>\n<li>Eligible for Medicare Part A\u00a0<\/li>\n<li>Enrolled in Medicare Part B<\/li>\n<\/ul>\n<p>Medicare Part D helps beneficiaries pay for prescription drugs. You don&#8217;t have to enroll unless you also receive Medicaid. If so,\u00a0the government will automatically\u00a0enroll\u00a0you in Medicare Part D.<\/p>\n<h2>How much does Medicare Part D cost?<\/h2>\n<p>Medicare Part D requires you to pay premiums, deductibles, and copayments. It\u00a0also has a coverage gap,\u00a0during which you pay full price for all of your prescription costs. Referred to as the &#8220;Donut Hole,&#8221;\u00a0the\u00a0gap begins once\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/medicare.html\">Medicare<\/a>\u00a0has paid a certain dollar amount for your prescriptions. Once you have paid an out-of-pocket amount, the prescription drug coverage gap ends. You are only responsible for the co-payments for the rest of that calendar year.<\/p>\n<p><a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/choosing-a-medicare-part-d-plan.html\">Medicare Part D<\/a>\u00a0plans pick and choose what types of drugs and brands they want to cover based on the prescription drug plan. They can also choose to deny coverage altogether. You should review the different Part D plans carefully to choose the one that is best suited for your needs.<\/p>\n<h2>Can I get any of Medicare Part D&#8217;s costs waived?<\/h2>\n<p>If your income is below a certain amount, you may qualify for\u00a0<a href=\"https:\/\/www.findlaw.com\/socialsecurity\/disability\/what-is-the-difference-between-ssdi-and-ssi-.html\" rel=\"noopener noreferrer nofollow\">supplemental assistance from Social Security<\/a>. In certain situations, your copayments may be significantly reduced, or even waived. You may qualify for this copayment assistance if\u00a0any of the following apply:<\/p>\n<ul>\n<li>You&#8217;re eligible for Medicaid<\/li>\n<li>You have an income level that does not reach above 149%\u00a0of the federal poverty level<\/li>\n<li>You live in a long-term nursing home, are enrolled in Medicaid, and are enrolled in Medicare Part D<\/li>\n<\/ul>\n<p>You also may qualify for assistance through pharmacies and drug companies if you:<\/p>\n<ul>\n<li>Take certain types of medications, like generic brands<\/li>\n<li>Use a pharmacy that waives copayments for those under a certain income (ask your pharmacy if it participates in this program)<\/li>\n<\/ul>\n<h2>How much does Medicare cost?<\/h2>\n<p><a href=\"https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/medicare-basics\/what-does-medicare-cost\" target=\"_blank\" rel=\"noopener\">Medicare costs<\/a>\u00a0vary\u00a0based on your medical needs and choice of coverage. The following are an idea of\u00a0what you may have to pay:<\/p>\n<h3>Part A costs<\/h3>\n<p>Most people pay no premium if they or their spouse has earned 40 quarters of Medicare-covered employment. Beneficiaries face annual deductibles and coinsurance for hospital admissions. For 2025, individuals pay $1,676 as their deductible per benefit period. Beneficiaries pay a deductible that covers part of the costs for a Medicare-approved inpatient hospital stay within the first 60 days of each benefit period.<\/p>\n<h3>Part B costs<\/h3>\n<p>For\u00a0<a href=\"https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/medicare-basics\/what-does-medicare-cost\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Medicare Part B<\/a>, the standard monthly premium cost is $185 for 2025. The annual deductible for beneficiaries of Medicare is $257.\u00a0<\/p>\n<p>Since 2007, the monthly premium for Medicare Part B has been adjusted for higher-earning beneficiaries.\u00a0Higher-earning beneficiaries pay an additional Income-Related Monthly Adjustment Amount. This amount is often based on the Modified Adjusted Gross Income from the past two years.<\/p>\n<h2>When does a higher premium for Medicare Part B apply?<\/h2>\n<p>A higher premium for Medicare Part B applies when, two years earlier, your modified adjusted gross income exceeds a\u00a0<a href=\"https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/medicare-basics\/what-does-medicare-cost#:~:text=Who%20pays%20a%20higher%20premium%20because%20of%20income%3F\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">certain threshold<\/a>:<\/p>\n<ul>\n<li>$106,000 for individual filers or married individuals filing separately<\/li>\n<li>$212,000\u00a0for married individuals filing jointly<\/li>\n<\/ul>\n<p>Social Security determines whether you have to pay these higher premiums. If you experienced life-changing events that potentially lowered your household income, you can contact Social Security. They can reduce the additional premium you have to pay.<\/p>\n<h2>How do I enroll in Medicare?<\/h2>\n<p>If you are already receiving Social Security benefits at least four\u00a0months before you turn 65, you will be automatically enrolled in\u00a0<a class=\"editor-rtfLink\" href=\"https:\/\/www.cms.gov\/medicare\/enrollment-renewal\/original-part-a-b\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Medicare Parts A and B<\/a>. However, Medicare enrollment is not always automatic. You need to enroll during your Initial Enrollment Period (IEP) if you are not receiving Social Security benefits when you turn 65 years old. The enrollment period lasts for seven\u00a0months\u00a0and\u00a0starts three\u00a0months before your 65th birthday. The period ends three\u00a0months after you turn 65 years old.<\/p>\n<p>If you are eligible for Medicaid or Medicare based on disability, you may also qualify to receive Parts A and B. This may only happen if you have\u00a0received\u00a0disability benefits for 24 months.<\/p>\n<p>You can apply for Medicare by contacting the\u00a0<a class=\"editor-rtfLink\" href=\"https:\/\/www.ssa.gov\/agency\/contact\/phone.html\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Social Security Administration at 1-800-772-1213<\/a>\u00a0and speaking with a representative about enrollment options.<\/p>\n<h2>What if I need a referral for specialist care?<\/h2>\n<p>Original Medicare (Parts A and B) does not\u00a0<a class=\"editor-rtfLink\" href=\"https:\/\/www.medicare.org\/articles\/does-medicare-require-a-referral-to-see-a-specialist\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">require referrals<\/a>\u00a0to see specialists. This\u00a0allows\u00a0beneficiaries to make appointments with Medicare-approved specialists directly.\u00a0<\/p>\n<p>Medicare Advantage plans often require referrals. Most\u00a0Health Maintenance Organization (HMO) Plans require a physician&#8217;s referral for specialists.<\/p>\n<p>Insurers may have policies that require different guidelines. Consult a representative about your plan to look at their policies related to seeking specialist care.<\/p>\n<h2>What are the biggest mistakes that people make with Medicare?<\/h2>\n<p>Some mistakes are more common than others\u00a0when navigating Medicare. Enrollment periods and decisions related to choosing a health plan can cause confusion. The following are some of the most common mistakes\u00a0associated with\u00a0Medicare plans:<\/p>\n<h3>Missing Enrollment Deadlines<\/h3>\n<p>Many people fail to enroll during the Initial Enrollment Period. The delay in enrollment could result in\u00a0<a href=\"https:\/\/www.medicare.gov\/basics\/costs\/medicare-costs\/avoid-penalties\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">late enrollment penalty<\/a>\u00a0or fees. It could also increase your premium payments.<\/p>\n<h3>Not Understanding Cost-Sharing Requirements<\/h3>\n<p>Some assume Medicare covers 100% of their\u00a0medical services.\u00a0That is not the case. For most doctors&#8217; visits and outpatient care, you often have to pay 20% of the cost.\u00a0Medicare pays 80% after\u00a0you meet your deductible.\u00a0<\/p>\n<p>The\u00a0<a class=\"editor-rtfLink\" href=\"https:\/\/www.medicare.gov\/health-drug-plans\/part-d\/basics\/costs\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">costs for prescription drugs<\/a>\u00a0are more complex and can vary due to the plan you have. In 2025, a\u00a0deductible of up to $590\u00a0may apply. Once that&#8217;s met, you&#8217;ll be responsible for\u00a025%\u00a0of drug costs\u00a0until\u00a0reaching\u00a0$2,000 in out-of-pocket costs.<\/p>\n<h3>Not Understanding the Part B Income-Related Monthly Adjustment Amount (IRMAA)<\/h3>\n<p>The\u00a0<a class=\"editor-rtfLink\" href=\"https:\/\/www.ssa.gov\/benefits\/medicare\/medicare-premiums.html\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">additional premium<\/a>\u00a0payment for those with higher incomes can come as a shock.\u00a0Higher-income beneficiaries whose income exceeds a certain amount pay a higher Medicare Part B premium, which is often based on the beneficiary&#8217;s income.<\/p>\n<h3>Assuming All Plans Are the Same<\/h3>\n<p>It&#8217;s normal to want to pay as little as possible, but that&#8217;s not always the best option.\u00a0Before choosing\u00a0the cheapest\u00a0<a href=\"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/choosing-a-medicare-part-d-plan.html\">Part D plan<\/a>,\u00a0\u00a0check to make sure\u00a0the plan covers the specific medication(s) you\u00a0take.<\/p>\n<p>Enrollees in the\u00a0Part D plan pick and choose which prescriptions and brands they cover. There&#8217;s no\u00a0switching of\u00a0plans during the year. If a required drug isn&#8217;t on the chosen list, coverage can be denied. These factors can\u00a0leave beneficiaries stuck with a plan that does not cover their expensive medications.<\/p>\n<h3>Thinking Medicare Covers Long-Term Care<\/h3>\n<p>Medicare\u00a0<strong data-redactor-tag=\"strong\" data-verified=\"redactor\">does not<\/strong>\u00a0cover\u00a0long-term care or custodial care.\u00a0Neither does\u00a0Supplemental Insurance. Medicare does not classify long-term care as medical care. They look at long-term care as support to the beneficiary for the basic daily activities. This may include assistance with personal care such as bathing, dressing,\u00a0using the bathroom, home delivered meals,\u00a0and adult day health care.\u00a0<\/p>\n<p>With this in mind, it&#8217;s a good idea to\u00a0start planning your non-medical long-term care ahead of time to ensure that you&#8217;ll\u00a0be able to afford the support you&#8217;ll need later in life.\u00a0If you have concerns or questions about Medicare, consider\u00a0contacting\u00a0a\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/health-health-care-law\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">healthcare attorney.<\/a>\u00a0They can assess your case and help you avoid these common pitfalls related to Medicare.<\/p>\n<h2>What are the things Medicare does not cover?<\/h2>\n<p>Medicare has limitations in coverage that beneficiaries should understand when they are planning their health care services. If there are items or services that\u00a0<a href=\"https:\/\/www.medicare.gov\/providers-services\/original-medicare\/not-covered\" target=\"_blank\" rel=\"noopener\">Medicare does not cover<\/a>. There are some exceptions, such as:<\/p>\n<ul>\n<li>You have supplemental health coverage insurance that helps cover those costs<\/li>\n<li>You are enrolled in other Medicare Plans such as Medicare Advantage Plan (Part C), Medicare Cost Plan,\u00a0or\u00a0<a href=\"https:\/\/www.cms.gov\/medicare\/medicaid-coordination\/about\/pace\" target=\"_blank\" rel=\"noopener\">Program of All Inclusive Care for the Elderly (PACE)<\/a>, which\u00a0cover other services not covered by original Medicare such as dental, hearing, or vision services<\/li>\n<\/ul>\n<p>Medicare does not cover the following medical services:<\/p>\n<ul>\n<li>Vision examination for prescription eyeglasses<\/li>\n<li>Long-term care facility and custodial care<\/li>\n<li>Cosmetic surgical procedures<\/li>\n<li>Massage therapy and similar alternative treatments<\/li>\n<li>Routine wellness examinations<\/li>\n<li>Hearing aids and related fitting examinations<\/li>\n<li>Concierge medicine<\/li>\n<li>Services from providers who do not participate in Medicare programs<\/li>\n<li>Most dental health care services including\u00a0routine cleanings, fillings, extractions, and dentures<\/li>\n<\/ul>\n<p>Other services may not be covered as well.<\/p>\n<h2>Seek Legal Guidance From a Healthcare Attorney<\/h2>\n<p>If you are facing issues related to Medicare,\u00a0it&#8217;s a good idea to speak with\u00a0a\u00a0<a href=\"https:\/\/lawyers.findlaw.com\/health-health-care-law\/?fli=dcta\" target=\"_blank\" rel=\"noopener\">healthcare attorney<\/a>.\u00a0They can help you navigate the federal regulations and ensure that you receive health coverage that you deserve under federal law. They also understand the complexities of the health system and advocate for your rights.\u00a0\u00a0<\/p>\n<p>For immediate assistance with basic Medicare questions, you can also contact the official Medicare helpline at 1-800-MEDICARE or visit\u00a0<a href=\"http:\/\/medicare.gov\/\" target=\"_blank\" rel=\"noopener noreferrer nofollow\">Medicare.gov<\/a>.<\/p>\n\n\n<div class=\"was-this-helpful\">\n    <div\n            class=\"was-this-helpful__question-container\"\n            aria-labelledby=\"was-this-helpful__question\"\n            role=\"group\"\n    >\n        <span\n                id=\"was-this-helpful__question\"\n                class=\"was-this-helpful__question fl-text-lg-bold\"\n        >Was this helpful?<\/span>\n        <button\n                class=\"was-this-helpful__button fl-text-sm\"\n                aria-label=\"Yes\"\n                value=\"yes\"\n        >\n            <span class=\"was-this-helpful__button-text fl-text-bold\">Yes<\/span>\n            <i class=\"was-this-helpful__button-icon\">\n                <svg width=\"22\" height=\"22\" viewBox=\"0 0 22 22\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <g id=\"thumbs-up\" clip-path=\"url(#clip0_604_3418)\">\n                        <path id=\"Vector\"\n                              d=\"M6 21H3C2.46957 21 1.96086 20.7893 1.58579 20.4142C1.21071 20.0391 1 19.5304 1 19V12C1 11.4696 1.21071 10.9609 1.58579 10.5858C1.96086 10.2107 2.46957 10 3 10H6M13 8V4C13 3.20435 12.6839 2.44129 12.1213 1.87868C11.5587 1.31607 10.7956 1 10 1L6 10V21H17.28C17.7623 21.0055 18.2304 20.8364 18.5979 20.524C18.9654 20.2116 19.2077 19.7769 19.28 19.3L20.66 10.3C20.7035 10.0134 20.6842 9.72068 20.6033 9.44225C20.5225 9.16382 20.3821 8.90629 20.1919 8.68751C20.0016 8.46873 19.7661 8.29393 19.5016 8.17522C19.2371 8.0565 18.9499 7.99672 18.66 8H13Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\"\n                              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20.2154 1.55681C20.645 1.9255 20.9242 2.43905 21 3V10C20.9242 10.5609 20.645 11.0745 20.2154 11.4432C19.7859 11.8119 19.236 12.01 18.67 12H16M9.00003 14V18C9.00003 18.7956 9.3161 19.5587 9.87871 20.1213C10.4413 20.6839 11.2044 21 12 21L16 12V0.999995H4.72003C4.2377 0.994543 3.76965 1.16359 3.40212 1.47599C3.0346 1.78839 2.79235 2.22309 2.72003 2.7L1.34003 11.7C1.29652 11.9866 1.31586 12.2793 1.39669 12.5577C1.47753 12.8362 1.61793 13.0937 1.80817 13.3125C1.99842 13.5313 2.23395 13.7061 2.49846 13.8248C2.76297 13.9435 3.05012 14.0033 3.34003 14H9.00003Z\"\n                              stroke=\"#666666\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n                    <\/g>\n                    <defs>\n                        <clipPath id=\"clip0_604_3423\">\n                            <rect width=\"22\" height=\"22\" fill=\"white\"\/>\n                        <\/clipPath>\n                    <\/defs>\n                <\/svg>\n            <\/i>\n        <\/button>\n    <\/div>\n    <span class=\"was-this-helpful__taken-action fl-text-sm-bold\"><\/span>\n    <div class=\"was-this-helpful__feedback-container\">\n        <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n            <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n        <\/div>\n        <form class=\"was-this-helpful__feedback-form\">\n            <div class=\"was-this-helpful__feedback was-this-helpful__feedback--positive\">\n                <fieldset>\n                    <legend class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this helpful?<\/legend>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--understandable\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Easy to understand\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--understandable\"\n                        >Easy to understand<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--solved-problem\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Solved my problem\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--solved-problem\"\n                        >Solved my problem<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--other\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"positive-feedback\"\n                                value=\"Other\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--other\"\n                        >Other<\/label>\n                    <\/div>\n                <\/fieldset>\n            <\/div>\n            <div class=\"was-this-helpful__feedback was-this-helpful__feedback--negative\">\n                <fieldset>\n                    <legend class=\"was-this-helpful__feedback-form-title\" tabindex=\"0\">Why was this not helpful?<\/legend>\n                    <div class=\"was-this-helpful__choose-option-message\" role=\"status\">\n                        <p class=\"was-this-helpful__choose-option-message-text\"><\/p>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--missing-info\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Missing Information\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--missing-info\"\n                        >Missing the information I need<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--complicated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Too complicated\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--complicated\"\n                        >Too complicated \/ too many steps<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--dated\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Out of date\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--dated\"\n                        >Out of date<\/label>\n                    <\/div>\n                    <div class=\"fl-radio-button-field fl-flex was-this-helpful__feedback-form-title\">\n                        <input\n                                id=\"was-this-helpful__radio-button--negative-other\"\n                                class=\"fl-radio-button-field-input\"\n                                type=\"radio\"\n                                name=\"negative-feedback\"\n                                value=\"Other\"\n                        >\n                        <label\n                                class=\"fl-radio-button-field-label fl-text-sm was-this-helpful__radio-label\"\n                                for=\"was-this-helpful__radio-button--negative-other\"\n                        >Other<\/label>\n                    <\/div>\n                <\/fieldset>\n            <\/div>\n            <div class=\"was-this-helpful__form-buttons-container\">\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--positive at-feedback-submit fl-button secondary\"\n                    type=\"submit\"\n                >\n                    <span class=\"fl-button-content\">Submit<\/span>\n                    <i\n                        class=\"fa fa-angle-right medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n                <button\n                    class=\"was-this-helpful__feedback-button was-this-helpful__feedback-button--cancel fl-button primary disabled\"\n                    type=\"reset\"\n                >\n                    <span class=\"fl-button-content\">Cancel<\/span>\n                    <i\n                        class=\"fa fa-times-circle medium\"\n                        aria-hidden=\"true\"\n                    ><\/i>\n                <\/button>\n            <\/div>\n        <\/form>\n    <\/div>\n    <div class=\"was-this-helpful__thank-you-message\" role=\"status\">\n        <i class=\"was-this-helpful__thank-you-message-icon fa fa-check\"><\/i>\n        <p class=\"was-this-helpful__thank-you-message-text\" aria-live=\"polite\"><\/p>\n    <\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"fl-section-sidebar\"><div class=\"fl-editors-summary\" data-testid=\"fl-editors-summary\">\n    \n    <div class=\"fl-editors-summary-content\" data-testid=\"fl-editors-summary-content\">\n                    <h2>Can I Solve This on My Own or Do I Need an Attorney?<\/h2>\n                <div class=\"fl-editors-summary-content-main\" data-testid=\"fl-editors-summary-content-main\">\n            \n        <\/div>\n        <ul class=\"fl-list-style-none\">\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    Medicare and Medicaid issues can often be handled on your own\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    Attorneys are helpful when the health care system is complex\n\n                <\/li>\n                            <li data-testid=\"fl-editors-summary-content-item\">\n                    <i class=\"fa fa-check medium fl-editors-summary-content-item-icon\" aria-hidden=\"true\"><\/i>\n                    Complex heath care cases (such as medical malpractice, bioethics, or health advocacy) may need the support of an attorney\n\n                <\/li>\n                    <\/ul>\n                    <div class=\"fl-editors-summary-content-description\" data-testid=\"fl-editors-summary-content-description\">\n                <p>Protect your patient rights with an attorney at your side. An attorney can offer tailored advice and help prevent common mistakes.<\/p>\n\n            <\/div>\n                            <div class=\"fl-editors-summary-content-link fl-flex\" data-testid=\"fl-editors-summary-content-link\">\n                <i class=\"fa fa-angle-right medium\" aria-hidden=\"true\"><\/i>\n                <p class=\"find-attorney\"><a href=\"https:\/\/lawyers.findlaw.com\/health-health-care-law\/#USER_GEO\/?fli=esum:FL28\" target=\"_blank\" rel=\"noopener\">Find a local attorney<\/a><\/p>\n\n            <\/div>\n            <\/div>\n<\/div>\n\n\n\n<div class=\"email-subscription fl-mb30\">\n    <div class=\"email-subscription-header\">\n        <div class=\"email-subscription-header-content\">\n            <h3 class=\"fl-callout-sm fl-no-margin\">Stay Up-to-Date With How the Law Affects Your Life<\/h3>\n        <\/div>\n        <div class=\"email-subscription-header-image fl-flex fl-items-end\">\n            <img decoding=\"async\"\n                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<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Medicare is a U.S. government-run health care system for older Americans, divided into four main plans. Learn about Medicare and more at FindLaw&#8217;s Health Care Law Center.<\/p>\n","protected":false},"author":41135,"featured_media":0,"parent":355784,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"app\/Http\/Controllers\/Templates\/ArticleWithBreadcrumbsController.php","meta":{"_acf_changed":false,"_stopmodifiedupdate":true,"_modified_date":"","_autodraft_ids":[],"_cloudinary_featured_overwrite":false,"_sb_is_suggestion_mode":false,"_sb_show_suggestion_boards":false,"_sb_show_comment_boards":false,"_sb_suggestion_history":"","_sb_update_block_changes":"","_is_real_time_mode":false,"_realtime_collaborators":"","footnotes":"","cf_checklist_status":[]},"categories":[2740],"tags":[],"state_laws_tags":[],"flmsa":[],"class_list":["post-355791","page","type-page","status-publish","hentry","category-healthcare"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages\/355791","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/users\/41135"}],"replies":[{"embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/comments?post=355791"}],"version-history":[{"count":1,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages\/355791\/revisions"}],"predecessor-version":[{"id":397888,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages\/355791\/revisions\/397888"}],"up":[{"embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/pages\/355784"}],"wp:attachment":[{"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/media?parent=355791"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/categories?post=355791"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/tags?post=355791"},{"taxonomy":"state_laws_tags","embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/state_laws_tags?post=355791"},{"taxonomy":"flmsa","embeddable":true,"href":"https:\/\/www.findlaw.com\/law-api\/wp-json\/wp\/v2\/flmsa?post=355791"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}