What is covered? How to use the Medicare website to better understand Original Medicare coverage
Many people want to know how Original Medicare will cover a specific health condition, treatment, service, etc. Fortunately for me, as an agent, and for you, as a Medicare beneficiary, the Medicare.gov website makes it easy to find it. For example, I’m going to look up how Original Medicare covers kidney dialysis. First, I go to medicare.gov. On the home page, you will see a search field. This is where you can type the service you want to learn more about. Once I’ve typed Kidney Dialysis, I hit “GO” and within seconds, a list of services appears, with dialysis services and supplies coming first. I click on the link and I am taken to a detailed coverage summary. Coverage for inpatient versus outpatient care, home dialysis training, support services, equipment and supplies, and certain home dialysis drugs that are covered by Original Medicare are discussed. In addition to a list of what is covered, there is a brief mention of what is not. Medicare does not pay for aides who help with home treatment, any missed payments during self-dialysis training, a place to stay during your treatment, and blood or concentrated red blood cells for home self-dialysis unless it is part of the home care service. a doctor. The page then details how much Medicare will pay for the coverage offered, which in this case appears to be an 80/20 split for just about everything. This is where Medicare Supplements come in to help you with your out-of-pocket costs. As you can see, with Original Medicare along with a Supplement, your coverage will be pretty comprehensive.
Medicare.gov also explains, in broader terms, what Parts A and B cover. There is a link to “What Part A covers,” as well as a link to “What Part B covers.” I really love the Medicare website, I think it’s very well done, and I encourage you to explore it further!
As I mentioned earlier with kidney dialysis, Medigap policies fill in the gaps in Original Medicare coverage for different services and treatments. For example, Medicare pays for the first 60 days of a hospital stay (there’s a deductible that must be met before you pay anything), but from days 61 to 90 you pay coinsurance every day, which is $304 per day. All Medigap plans cover this gap in hospital coverage, and this is good news, because coverage gets even worse the longer you stay in the hospital. Days 91-150 include $608 daily coinsurance. A Medigap plan will cover this and you won’t have to worry about these coverage gaps with Medicare. In fact, Medicare supplemental hospital coverage will increase to an additional 365 days of coverage beyond what Original Medicare will help cover.
A quick note: There have been stories in the news lately about labeling hospital patients as outpatients instead of inpatients and making sure you know your classification. This is another important factor in whether Medicare will cover the costs; how they label it can determine whether Medicare will pay. Part A (which covers the hospital stay) will pay if you’re labeled an inpatient, and Part B (which doesn’t cover the hospital stay) will pay if you’re an outpatient. I’m going to write a blog about this soon; Stay tuned for more detailed information!
The list below should help you understand what is and is not covered by Original Medicare (and therefore Medicare Supplements):
1.Dental and vision
2. Nothing cosmetic is covered.
3. If it’s routine, preventative, and sort of a yearly treatment, chances are they’ll help, though it’s always good to check with Medicare.
4. If your doctor is a Medicare provider and accepts Medicare Assignment.
It is important to understand my fourth point in the list of basic rules. After making sure your supplier works with Medicare, your next question should be whether or not they accept Medicare Assignment. This is a term used to describe the price for service that Medicare is willing to pay. For example, if Medicare pays $1,200 for a certain surgery, if the doctor accepts Medicare Assignment, he or she is accepting this amount as payment for the surgery. Physicians who work with Medicare may charge an additional 15% above the Allowed Amount ($1,200), which means they do not accept Medicare Assignment even if they work with Medicare. Now you see why it is imperative that you ask these two questions before receiving any service from a provider. Medicare Supplement Plans F and G cover this 15% “excess charge” for Part B services.
There are many nuances like the above, but the ones in this article are the main players in the game. I hope this article has given you a better understanding of what Original Medicare covers and how Medicare Supplements work together with Parts A and B.
I’ve also made a YouTube video that will give you a visual of this article and also introduce you to my website, which has more information on how Medicare Supplements with Parts A and B work. The link for that video is below! !