Avoid surprise bills by knowing what Medicare covers
Because Medicare is so complex, seniors can end up getting blindsided by huge medical or prescription medication costs when the bills arrive.
That’s why it’s important to figure out what Medicare will cover, what counts toward the deductible, what the co-pay will be, and how much will be paid out of pocket.
Estimating costs ahead of time means everyone will be better prepared when the bills arrive.
What Medicare covers is also important to know when it’s time to choose your older adult’s healthcare and prescription drug plans for the next year. Being able to estimate costs ahead of time steers you toward plans that maximize coverage and minimize expenses.
We explain how to find out if something will be covered by Medicare, how to estimate costs for complex services, and where to get help understanding Medicare benefits.
What does Medicare cover? 3 steps to find out
In general, diagnostic tests (like x-rays or CT scans), preventive care check-ups, most surgeries, and hospital stays are covered.
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, item, 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 will have to pay.
If the search doesn’t show the item you’re looking for, Medicare also provides an alphabetical list of various services and medical equipment. Click through an item to check the coverage.
How to estimate costs for complex services
If your older adult needs something more complex like surgery, look it up and also review the additional instructions on how to estimate those costs.
Generally, 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
Get 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
- What Medicare Part D drug plans cover
Free state insurance counseling programs are available to help
If you have trouble estimating costs for your older adult’s medical care, you’re not alone – it can get confusing.
Take advantage of the free counseling available through 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 Coverage for Hospital Stays: Inpatient vs Observation Status
- What Medicare Does and Doesn’t Cover for Alzheimer’s Care
- Medicare vs. Medicaid: What You Need to Know
By DailyCaring Editorial Team
This article wasn’t sponsored and doesn’t contain affiliate links. For more information, see How We Make Money.