Many people want to know how Original Medicare will cover a health condition, treatment, service, etc. specific. Fortunately for me, as an agent, and for you, as a Medicare beneficiary, the Medicare.gov website allows you to search for this easily. 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 in the service you want to learn more about. Once I’ve typed in Kidney Dialysis, I press “GO” and within a few seconds, a list of services appears, with dialysis services and supplies being first. I click the link and go to a detailed summary of coverage. Discusses inpatient versus outpatient coverage, home dialysis training, support services, equipment and supplies, and certain home dialysis medications that are covered by Original Medicare. In addition to a list of what is covered, there is a brief mention of what is not. Medicare does not pay for assistants to help with home treatment, any missed payments during self-dialysis training, a place to stay during your treatment, and blood or packed red blood cells for home self-dialysis, unless it is part of a service 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 almost everything. This is where Medicare Supplements come in to help you with out-of-pocket costs. As you can see, with Original Medicare along with a Supplement, your coverage will be quite 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 is very well done and I urge you to explore it more.
As I mentioned previously with Kidney Dialysis, Medigap policies fill gaps in Original Medicare coverage for different services and treatments. For example, Medicare pays for the first 60 days of a hospital stay (there is a deductible that must be met before you pay for 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 worse the longer you stay in the hospital. Days 91-150 include daily coinsurance of $608. A Medigap plan will cover this and you will not have to worry about these gaps in Medicare coverage. In fact, Medicare supplemental hospital coverage will increase up 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 their classification. This is another important factor in determining 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 are considered an inpatient, and Part B (which does not cover the hospital stay) will pay if you are an outpatient. I will blog about this soon; Stay tuned for more detailed information!
The following list should help you have a basis for understanding what Original Medicare (and therefore Medicare Supplements) does and does not cover:
1. Dental and vision
2. Nothing cosmetic is covered.
3. If it is a routine, preventive, annual treatment, they will most likely help you, although it is 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 provider 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. Doctors who work with Medicare can charge an additional 15% above the Approved Amount (the $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 both 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 previous one, but those 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 along with Parts A and B.
I also made a YouTube video that will give you a visual look at this article and also introduce you to my website, which has more information on how Medicare supplements work with Parts A and B. The link for that video is below! continuation!
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