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  • Writer's pictureGeorge Kolitsas

How Do I Know If Medicare Covers A Procedure?

Medicare covers a significant amount of important benefits. But sometimes, finding out if your needs are covered is difficult. Here is a coverage overview and how to find out if you can get the healthcare you need.

Original Medicare Coverage Overview

Original Medicare (Parts A and B) provide vital coverage for a variety of needs. When you are figuring out whether or not a certain benefit is covered, think in these general terms first.

Medicare Part A covers emergency hospital and nursing home facility stays. If you need emergency treatment, Part A has you covered. You are able to stay up to 60 days per year with no out-of-pocket costs. After 60 days, you will be required to take on some of the costs yourself, but the 60 days resets each year.

Part B coverage is a bit more tricky. It covers general medical needs from durable medical equipment to preventative treatments. Anything considered “medically necessary” to your health may be covered by this plan.

Medicare Coverage Across the U.S.

Medicare has a long list of benefits that are covered for every beneficiary regardless of health factors. The entire list is far too lengthy to include here. However, there are a few categories to keep in mind.

You will receive a “Welcome to Medicare” preventive visit when you first enroll. After that, you receive yearly “wellness” visits to keep up-to-date on your health. A lot of the covered benefits fall under the “preventative care” category, including multiple screenings for depression, alcohol misuse, mammograms, gym memberships, shots, and more.

It also covers a variety of inpatient and outpatient care and therapy, including mental health care, occupational and physical therapy, radiation therapy, and much more. Chemotherapy, blood necessities, long-term and nursing home care, various surgeries, mobility devices, and much more are all covered no matter where you live.

Finding Out What Medicare Covers in Your Situation

But what happens if you’re not sure if your need is on the list of covered benefits? If Medicare considers it “medically necessary,” chances are it is covered. Specific coverage may vary based on:

  1. Federal and state laws for benefits or what practitioners are licensed to provide.

  2. National regulations on offered coverage.

  3. Local decisions by companies on what is considered “medically necessary.”

The best way to determine if something is covered is simply by talking with your doctor. Ask if they think it will be covered—they will know your medical needs better than anyone.

A “Medicare & You” handbook is mailed out every fall for beneficiaries to review their coverage. It will provide insight and general lists of what is covered and how much you will have to pay for the policy.

Call Innovative Senior Benefits Today

Medicare provides essential coverage—but it can be very difficult to understand. Innovative Senior Benefits will make sure that you understand your policy every step of the way. To learn more, call 203-217-3366.

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