Many people want to know how Original Medicare will cover a specific health condition, treatment, service, etc. Fortunately for me as an agent, and for you as a Medicare beneficiary, the Medicare.gov website makes it easy to find. For example, I’m going to look up 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’ve typed in Kidney Dialysis, I hit “GO” and within seconds, a list of services appears, with dialysis services and supplies at the top. I click the link and am taken to a detailed summary of coverage. Discusses coverage for inpatient versus outpatient, home dialysis training, support services, equipment and supplies, and certain drugs for home dialysis 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 doesn’t pay for aides to help with home treatment, any payments missed during self-dialysis training, a place to stay during your treatment, and blood or packed red blood cells for home self-dialysis unless it’s part of the service from a doctor. 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 almost 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 pretty 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’s 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 a hospital stay (there is a deductible that must be met before anything is paid), but from days 61 to 90 you pay coinsurance every day, which is $304 per day. All Medigap plans cover this hospital coverage gap, and this is good news, because coverage gets 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 coverage gaps with Medicare. In fact, Medicare Supplement hospital coverage will increase to an additional 365 days of coverage beyond what Original Medicare will help cover.

One quick note: There have been stories in the news lately about labeling hospital patients as outpatients instead of inpatients and making sure you know their classification. This is another important factor in knowing if Medicare will cover the costs; how they label it can determine if Medicare will pay. Part A (which covers a hospital stay) will pay if you’re labeled an inpatient, and Part B (which doesn’t cover a hospital stay) will pay if you’re an outpatient. I’m going to blog about this soon; Stay tuned for more detailed information!

The list below should help you understand what is and is not covered by Original Medicare (and therefore Medicare Supplements):

1.Dental and vision

2. Nothing cosmetic is covered.

3. If it’s routine, preventative, and sort of an annual treatment, they will most likely help you, although it’s 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 basic rules. After making sure that your provider works with Medicare, your next question should be whether or not to accept Medicare Assignment. This is a term used to describe the price for service that Medicare is willing to pay. For example, if Medicare pays $1,200 for a certain surgery, if the doctor accepts the Medicare Assignment, he or she is accepting this amount as payment for the surgery. Doctors who work with Medicare can charge an additional 15% above the Approved Amount (the $1,200), which means they don’t accept Medicare Assignment even though they work with Medicare. Now you 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% “excess charge” for Part B services.

There are many nuances like the one above, but the ones in this article are the main players in the game. I hope this article has given you a better understanding of what Original Medicare covers and how Medicare Supplements work alongside Parts A and B.

I also made a YouTube video that will give you a visual idea of ​​this article and will 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 at continuation!