Medicare Insurance Overview

What is Covered by Medicare?

For many people, Medicare is a godsend. Indeed, it covered many medical procedures and care. However, Medicare will only cover when the need for the procedure or care is documented. That means, they will not cover things that would be good to have done, but are not necessary. If someone is in a nursing home, home health care, or hospital, Medicare Part A will pick up covered costs. For everyone else, Medicare B will provide coverage.

Types of medical care and procedures typically covered by Medicare:

  • Ambulance Services
  • Approved Dental Surgery Related to a Covered Procedure
  • Approved Home Health Care
  • Cardiovascular Screening and Cardiac Rehabilitation Programs
  • Diabetes Screening
  • Diabetic Foot Exams
  • Emergency Room Visits
  • Mammogram Screening
  • Oxygen Therapy
  • Skilled Nursing Facility Care
  • Vaccinations

If a procedure or care protocol can be absolutely demonstrated as medically necessary, Medicare will cover other costs. However, your doctor must provide documentation in your records.

Some types of care are simply not covered whatsoever. For example:

  • Alternative Therapy
  • Hearing Exams and Aids
  • Routine Physical ExamsRoutine Dental Services
  • Travel Coverage

What are the costs associated with services and procedures?

Your costs will hinge upon your enrollment in Medicare Part B and which physician or medical professional provides your procedure and care. Typically, if you are covered by Medicare Part B, then the following conditions are true:

  • If you have already paid your annual deductible amount of $135, in the absence of secondary insurance Medicare will pay 80% of the approved amount. This will leave you with 20% of the approved costs to be paid out-of-pocket.
  • If you are covered under the Medicare Advantage Health Plan, your out-of-pocket expenses will be next to nothing. Your costs will vary depending upon your specific plan.

It’s up to you to be informed and know your plan.

Educate yourself on the circumstances impacting your amount of coverage. Ensure that your paperwork is accurately filled out and submitted. Always seek and receive care from an approved physician or provider, who will accept Medicare assignment.