Medicare coverage is confusing
It’s hard to know what Medicare will and won’t cover and how much your senior will end up paying.
In general, diagnostic tests (like x-rays or CT scans), preventive care check-ups, most surgeries, and hospital stays are covered. Long term care, dental, and hearing aids aren’t covered.
How can I find out if something is covered or not?
Your older adult’s doctor or medical facility and the Medicare.gov website are the best places to check. Here’s how to find out if something is covered.
- Ask the doctor or medical facility if they accept your specific Medicare plan for whatever is getting done – office visit, test, procedure, etc.
- Go to this page on the Medicare website, then enter the test, item, or service and click “Go” to search for that thing.
- Usually, clicking on the first or second search result will tell you if that thing is covered and how much you’ll need to pay.
If you’re looking up something more complicated like surgery, there are instructions on how to estimate the costs for your situation based on:
- How much the doctor or hospital will charge
- If you have other insurance plans
- How much of your deductible is left.
Why do I have to pay anything?
Even if something is covered by Medicare, you’ll most likely have to pay a deductible or co-pays. That can add up so it’s best to estimate costs before having anything done.
It takes some work and is an annoying chore, but at least you can plan ahead and won’t get a nasty surprise when the bill shows up.
Still confused? Free help is available
If you have trouble estimating costs for your senior’s medical care, we don’t blame you. It’s really confusing. You can get help from a State Health Insurance Assistance Program (SHIP) counselor about your situation.
It’s free! These counselors can be trusted because it’s an official state program. Here’s more info about each state’s SHIP and their free services.
More info on Medicare coverage
The Medicare website also has this page, which has lots of information about the different things that are and aren’t covered. The ones we thought were most useful are:
- What drugs are covered by which drug plans
- Find a doctor, hospital, facility, or plan that accepts Medicare
- Find local shops for medical equipment and supplies
By DailyCaring Editorial Staff