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 makes it easy for you to search. For example, I’m going to find out 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 the service you want more information about. Once I have typed Kidney Dialysis, I press “Continue” and within seconds a list of services appears, with dialysis services and supplies first. I click on the link and it takes me to a detailed summary of the coverage. Discusses inpatient versus outpatient coverage, home dialysis training, support services, equipment and supplies, and certain home dialysis drugs 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 aides to help with home treatment, no payments missed during self-dialysis training, a place to stay during your treatment, and blood or red blood cell concentrate for home self-dialysis, unless you are part of a medical service. 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 just about everything. This is where Medicare Supplements come in to help you with your 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 further!
As I mentioned earlier with Kidney Dialysis, Medigap policies fill in the gaps in Original Medicare coverage for different services and treatments. For example, Medicare pays for the first 60 days of an inpatient stay (there is a deductible that must be met before anything is paid), but between days 61 and 90 you pay coinsurance every day, which is $ 304 per day. day. All Medigap plans cover this hospital coverage gap, and this is good news, because coverage gets even worse the longer you stay in the hospital. Days 91-150 include a daily coinsurance of $ 608. A Medigap plan will cover this and you won’t have to worry about these gaps in Medicare coverage. In fact, Medicare Supplement hospital coverage will increase to an additional 365 days of coverage beyond what Original Medicare will help cover!
A quick note: lately there have been stories in the news about labeling hospital patients as outpatients instead of hospitalized 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 labeled 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 list below should help you understand what is covered and what is not covered by Original Medicare (and therefore Medicare supplements):
1. Dental and vision
2. No cosmetics are covered.
3. If it is a routine, preventive and 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 ground rules. After making sure your supplier works with Medicare, your next question should be whether or not to accept the Medicare assignment. This is a term used to describe the price per service that Medicare is willing to pay. For example, if Medicare pays $ 1,200 for a certain surgery, if the doctor accepts Medicare’s assignment, they are accepting this amount as payment for the surgery. Doctors who work with Medicare can charge an additional 15% on top of the approved amount (the $ 1,200), which means that they do not accept the Medicare assignment even if they work with Medicare. Now see why it is imperative that you ask these two questions before receiving any service from a provider. Medicare Supplement Plans F and G cover this 15% “additional charge” for Part B services.
There are many nuances like the previous one, but those in this article are the main protagonists of the game. I hope this article has helped you better understand what Original Medicare covers and how Medicare Supplements work together with Parts A and B.
I also made a YouTube video that will give you a visual snapshot of this item 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! !