It’s important to know what Medicare does and doesn’t cover
It can be difficult to know what Medicare will and won’t cover and how much your older adult will end up paying out of pocket.
Even if something is covered, your older adult will most likely have to pay a deductible or co-pay. That can really add up, so it’s best to estimate costs beforehand so you’ll be prepared when the bills arrive.
We explain how to find out if something will be covered, how to estimate costs for complex services, and how to get help understanding Medicare benefits.
How to find out if something is covered
In general, diagnostic tests (like x-rays or CT scans), preventive care check-ups, most surgeries, and hospital stays are covered.
Use 3 steps to find out if something is covered:
- Ask the doctor or medical facility if they accept your older adult’s specific Medicare plan for whatever is getting done – office visit, test, procedure, etc.
- Go to this page on the Medicare.gov website, then enter the test or service and click “Go” to search for it.
- Usually, the first or second search result will tell you if that item is covered and how much the patient’s will have to pay.
If the search doesn’t show what you need, Medicare also provides an alphabetical list of various services and medical equipment that you can look through.
How to estimate costs for complex services
Generally, the costs will be based on:
- How much the doctor(s) and/or hospital will charge
- If your older adult has other insurance plans
- How much of their deductible remains
Additional information about Medicare coverage
The Medicare website also has helpful information about the different Parts of Medicare, preventive services, what to do in a disaster or emergency, and more.
Especially useful pages are:
- Find a doctor, hospital, facility, or plan that accepts Medicare
- Find local shops that sell covered medical equipment and supplies
- Which drugs are covered by which drug plans (click the link at the bottom)
Free state counseling programs are available
If you have trouble estimating costs for your older adult’s medical care, we don’t blame you. It’s confusing. Take advantage of the free counseling available at the State Health Insurance Assistance Program (SHIP).
SHIP are official state programs that help people understand their Medicare, Medicare Advantage, Medigap, and Medicaid benefits. Get more info about how these programs work and where to find your state’s SHIP.
Recommended for you:
- Medicare vs. Medicaid: What You Need to Know
- 5 Options for Medications Not Covered by Medicare
- What Seniors Need to Know About Medicare Coverage for Hospital Stays
By DailyCaring Editorial Team
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