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Medicare doesn’t cover everything. Some of the items and services Medicare doesn’t cover include:
• Most dental care
• Eye exams related to prescribing glasses
• Dentures
• Hearing aids and exams for fitting them
If you need services Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or a Medicare health plan that covers them.
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Medicare Options
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HMO (Health Maintenance Organization)
You usually have to use the doctors and other providers in the plan’s network. In an HMO with point-of-service option (HMOPOS), you may be able to go out-of-network for certain services. If you want drug coverage, the HMO Plan you join must include drug coverage.
PPO (Preferred Provider Organization)
These plans have a network of doctors and other providers, but you can use providers outside their network. You’ll usually pay less if you get services from in-network providers. If you want drug coverage, the PPO Plan you join must include drug coverage.
PFFS (Private Fee-for-service)
You can see any doctor or other provider that accepts the plan’s payment terms and agrees to treat you. Not all providers will, even if you’ve seen them before. If you join a PFFS Plan that doesn’t include drug coverage, you can also join a separate Medicare drug plan (Part D).
MSA (Medical Savings Account)
These are high-deductible plans that deposit money into a savings account that you can use to pay health care costs before you meet the deductible. You can see any doctor or provider. Once you’ve used the amount of money in the account, you’ll pay all costs until you meet the deductible. These plans don’t include drug coverage, but you can also join a separate Medicare drug plan.
Cost Plan
These plans are only available in some states. You can see any doctor or other provider that works with Medicare. If you go to a provider outside the network, Original Medicare covers those services. You’ll pay the Part A and Part B deductibles and coinsurance, usually 20% of the Medicare-approved amount, for those services.
You can join a Cost Plan without drug coverage anytime the plan’s accepting new members. You can also join a separate Medicare drug plan during an enrollment period.
If you want to join a Cost Plan with drug coverage, you can only join during an enrollment period.
MMP (Medicare-Medicaid Plan)
These plans are only in some states. You can join if you have Medicare, are getting full Medicaid benefits, and meet other criteria by the state. All MMPs include drug coverage.
Special Needs Plans
You can join this type of plan if you:
• Have both Medicare and Medicaid
• Have a specific disease or condition (like diabetes)
• Live in an institution (like a nursing home)
These plans tailor their benefits, provider network, and drug formularies to best meet the needs of the people they serve. All SNP Plans include drug coverage.
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