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Welcome to Medicare made (really) easy.

Is your test, item, or service covered by Medicare? How to find out

Whether you’re new to Medicare or have had it for a while, you’ve probably figured out pretty quickly that it’s not the same structure as health insurance. Medicare is in its own league — and that can come with a big learning curve. To help you better understand your Medicare benefits, learn what’s covered, and get all the other answers you need, keep reading — you’re sure to learn something new!  

 

What Medicare covers  

Medicare is uniquely divided into four Parts: A, B, C, and D. Think of each as a building block, which can be put together based on your needs and budget. Here’s a quick guide to each Medicare Part and some services they cover 

 

  • Medicare Part A is hospital insurance. These benefits include inpatient hospital stays, care in a nursing facility, hospice care, and some home health care. These benefits do not cover regular doctor visits or prescription drugs.  

  • Medicare Part B is medical insurance. These benefits include certain doctors’ services, outpatient care, labs, X-rays, medical supplies, and preventive services.  

  • Medicare Part C, or Medicare Advantage, is privatized, all-in-one health insurance. These benefits are the alternative to Original Medicare, bundled together with Parts A, B, and usually D. These Medicare benefits also sometimes cover dental care, vision care, over-the-counter items, and other specialized health needs. 

  • Medicare Part D is prescription drug coverage. These prescription drug coverage benefits include your prescription drugs, which are not covered in Parts A and B. 

  • Medigap (also known as a Medicare Supplement insurance plan) is extra health insurance you can buy from a private company to pay for health costs not covered by Original Medicare. Medigap plans are offered by private insurance companies. It’s designed to fill in the “gaps” in your overall Medicare costs. 

Want to learn more? Click here for the full breakdown of the different Parts of Medicare and services they cover. 

 
Understanding your Medicare benefits


If you’re enrolled in Original Medicare, it’s not always clear if a service or medical supply (like canes or crutches) is covered. Since Original Medicare is a benefit from the government, it’s up to federal, state, and local law to make coverage decisions, which can change from year to year. (Don’t worry, though: they typically stay the same.) 

 

Like we mentioned before, Medicare Parts A and B generally cover services like labs, surgeries, and doctor visits, as well as supplies like wheelchairs and walkers. But here’s the thing: it has to be considered “medically necessary” to get coverage. Plus, some services may only be covered when you get them in specific settings (like approved hospitals) to receive Medicare benefits.  

 

Confusing, right? The best way to learn more about what Medicare covers is by talking to your doctor or healthcare provider about why you need a service or supply and asking if they think Medicare will cover it. You can even speak with a physician’s assistant or insurance representative at the doctor’s office — they should have a pretty good idea of what is covered too. This is key — because most times, if you don’t ask, you’ll never know until you get the bill. 

 

But if you’re a planner-type, the “Medicare & You” handbook that is mailed to you by the government each fall will have this information:  

 

  • A general list of services covered by Medicare Part A and Medicare Part B. 

  • Information on getting Medicare Advantage (Part C) and Medicare Part D through a private plan.  

  • Yearly deductible information for Part A and Part B.  

  • Estimated costs for Part C and Part D.  

 

Let’s say you’re having surgery. This is how you find out how much you have to pay (and if it’s covered). 

 
If you need surgery or another invasive procedure, you probably don’t want any additional stress on your plate. And that includes any unexpected, higher costs. Though it might be difficult to determine the exact number you’ll pay for surgery, here are a few things you can do to get a closer estimate:  

 

  • Ask your doctor if they can tell you how much the procedure will cost and how much of that is your portion of the bill.  

  • If you have your last Medicare Summary Notice on hand, see if you met the deductible for Part A (if you expect to be admitted to the hospital) or Part B (for the doctor visits and outpatient care). For those new to Original Medicare, this notice is mailed to you every three months and shows all your services or supplies billed to Medicare during the three-month period, what Medicare paid, and the maximum amount you may owe.  

  • If you have Medicare Supplement (also known as Medigap) or Medicaid, check to see what they’ll pay. 

  • Call the hospital or facility where you are having your surgery done and ask them to tell you the co-pay for the procedure. (But keep in mind, if you need other unexpected services as a result of the surgery, like treating any complications, your costs may be higher.)

  • Ask your doctor about the care and services you need post-surgery, like follow-up appointments or tests, and how much they’ll cost.

  • Ask your doctor or healthcare provider if they accept assignment, which means they have signed an agreement with Medicare to accept the Medicare-approved amount as full payment for covered services. This can help you avoid upcharges and keep costs down.

 

Don’t be left in the dark when it comes to your Medicare coverage. It’s important to get the answers you need right when you need them — from costs to coverage to everything in between. 

Tags: Health, Care, Medicare

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