Medicare Phần A không đài thọ những gì

What does Medicare Part A not cover?

Medicare Part A is pretty straightforward in terms of what it covers, but there are some things you should know about what it doesn’t. There are also some rules about coverage under Part A that can make coverage trickier than it seems at face value.

For example, in order for Medicare Part A to cover your hospital stay, all of these things have to be true:

• You’re actually admitted to the hospital (i.e., not in “observation status,” which we’ll talk about in a second), and you’re there because of a doctor’s order saying you need to be there.
• The hospital you’re in accepts Medicare.
• Your stay is approved by the Utilization Review Committee (in some cases).

“Observation status” happens when you’re in the hospital but not as an inpatient. You may be in a hospital room, wearing a gown and everything, but still not be officially admitted to the hospital.

In these situations, Medicare Part A will not cover your hospital costs.

Because this can be such a problem for people, Medicare does require hospitals to give patients a heads up. If you’re under outpatient observation status for more than 24 hours, the hospital is required to give you the Medicare Outpatient Observation Notice (MOON). This tells you why you haven’t been admitted and alerts you to the fact that Part A may not cover your care.

But don’t rely on the hospital to give you notice, even if it’s required. When you’re in the hospital — because you planned to be or because there’s been an emergency — always ask your doctor whether you’re inpatient or not. Doing this up front might save you a headache and a larger bill later.

We should also mention that while Medicare Part A covers inpatient services, this may not extend to doctor’s services while you’re in the hospital. You would need to have medical coverage, such as Medicare Part B, to cover any charges that go beyond your covered Part A care.

Not Covered by Medicare Part A & B

•Routine dental care/dentures

•Cosmetic surgery

•Custodial/long term care

•Health care while traveling outside the US

•Hearing aids

•Outpatient prescription drugs (this is covered under Part D)

•Massage Therapy

•Routine eye care and eyeglasses

•Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

•Covered items or services provided by a doctor or other provider who has opted out of Medicare (except in the case of an emergency or urgent need)