5 Surprising Special Services Medicare Still Covers
Written by
Kerra Bolton
Edited by
Jenna Klaverweiden
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Many retirees think of Medicare when it comes to covering hospital visits and doctor’s appointments. However, Medicare still offers support for a range of special services. From Botox to in-home support, these benefits can make a significant difference in quality of life, especially as healthcare costs continue to rise.
Here are five surprising special services Medicare still covers.
Also see two important Medicare issues that Suze Orman wants you to understand.
Botox
While Botox is widely known for cosmetic use, Medicare may cover it when prescribed as a medically necessary treatment.
“It’s specifically approved for certain medical conditions,” said Kiara DeWitt, RN, CPN, founder and CEO of Injectco. “Chronic migraine is the main one, but other neurological disorders like cervical dystonia (a painful neck muscle condition), and blepharospasm count too.”
DeWitt explained that the catch is Botox isn’t covered for cosmetic use, so patients have to meet the clinical criteria. For example, Botox injections are sometimes approved for managing an overactive bladder or severe underarm sweating when other treatments have failed.
“You still need a provider who accepts Medicare and can submit the paperwork right,” DeWitt said. “Otherwise, you are paying hundreds per treatment when you technically qualify. The system will not advertise this, but it is buried in there. You just need a diagnosis that fits and a provider who knows how to code it.”
Dental Care
Original Medicare (Parts A and B) typically doesn’t include dental care. However, that doesn’t mean enrollees are out of options. Many are surprised to learn that certain dental services are covered under specific circumstances.
While routine dental care like cleanings and fillings isn’t covered under traditional Medicare, Part A may cover dental work if it’s part of a hospital-related procedure, such as jaw reconstruction after an injury or surgery that requires dental clearance.
“Medicare beneficiaries often are unaware that dental is included in Medicare Advantage Plans (Part C),” said Eric Salinas, a licensed health insurance agent at El-Mag Insurance.
For broader coverage, many Medicare Advantage (Part C) plans offer dental benefits that include exams, X-rays, cleanings and even dentures. These benefits vary by plan and location, so it’s worth reviewing available options during open enrollment to avoid paying out of pocket for essential oral healthcare.
Home-Based Care
Many beneficiaries are surprised to discover that Medicare still covers a range of home-based and mental health services under certain conditions.
From chronic care management, transitional care and telehealth counseling to the innovative GUIDE Model for dementia support, these benefits offer critical assistance for patients and caregivers.
“One of the most exciting developments is CMS’s (Centers for Medicare & Medicaid Services) GUIDE Model,” said Jared Laudie, owner of Visiting Angels. “It’s a new dementia care initiative that funds services like caregiver training, respite care and 24/7 care navigation for families managing Alzheimer’s or other dementias.”
However, the services are subject to specific eligibility criteria. “In-home medical care usually requires that the individual be homebound and under a physician’s care,” Laudie said. “Counseling often requires a diagnosis and provider referral.”
And be sure to know all of the requirements to make sure you qualify. “With the GUIDE Model, participation is limited to providers enrolled in the program, and patients must have a formal dementia diagnosis. Many people miss out simply because they don’t know what to ask for or which providers participate.”
Speech-Generating Devices
One lesser-known Medicare benefit is its coverage of speech-generating devices for individuals with conditions like ALS or advanced Parkinson’s disease that result in severe speech impairments.
These devices can be life-changing, allowing patients to communicate more effectively with caregivers and loved ones.
“But access depends on proper clinical documentation, including a formal evaluation by a qualified speech-language pathologist,” said Dr. Kimberly Idoko, a board-certified neurologist and medical director at Everwell Neuro.
Chronic Needs Support
For Medicare beneficiaries living with two or more chronic conditions, chronic special needs plans (C-SNPs) offer a tailored alternative that many overlook.
“For those eligible, these plans can provide additional benefits and resources not usually covered by Original Medicare or other Medicare Advantage plans,” said Whitney Stidom, vice president of Medicare enablement at eHealth. “For instance, some C-SNPs may provide additional resources for people with diabetes, including improved coverage for blood glucose monitoring supplies or access to lifestyle programs focused on improving nutrition and exercise habits. This can help people save on out-of-pocket costs to help treat their condition, while empowering them to adopt a healthier lifestyle.”
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