What is a “Medicare Covered Service” and how to use my Summary of Benefits

Medicare will cover certain medical services, making healthcare affordable for seniors. Different parts of Medicare will cover different services and medical procedures. There are a few factors that determine what services and supplies are covered by Medicare, including state and federal laws, Medicare national standard decisions and local coverage decisions that are processed by the state.

Medicare covered services
Medicare Part A covers services and tests that are considered medically necessary. These might include surgeries, lab tests and doctor visits, as well as some supplies such as wheelchairs or walkers. There are some services that aren’t covered or that are relegated to certain hospitals and doctors that are considered in network. In general, Part A covers hospital care, nursing home and skilled nursing facility care, as well as hospice and other health services. Since there is no premium for Part A, the services covered are often considered to be a great deal for seniors who need affordable healthcare.

Medicare Part B does require a monthly premium, but its covered services are broader. There are two types of services covered under Part B, including medically necessary services to diagnose a condition and preventive services used to prevent illnesses or treat them early. Under the new healthcare law, seniors may not have to pay anything for certain preventive services. Specifically, Part B covers clinical research, ambulance service, durable medical equipment, mental health services – including inpatient, outpatient and partial hospitalization – some outpatient prescription drugs and second opinions before a surgery.

Parts A and B are most commonly purchased or used by seniors, but others may choose to invest in a prescription drug plan in order to receive coverage for medicine. Prescription drug plans, also known as Part D, help seniors pay for medications. Medicare will generally cover a portion of certain prescriptions, based on the specific plan. Seniors have a choice between what type of prescription drug plan they want, based on a set of listed medications.

How to find out what Medicare covers
To find out what services are covered under the different parts of Medicare, seniors should speak with their doctor or healthcare provider about what services might be medically necessary. If a Medicare beneficiary needs a service or medical equipment that is usually covered by Medicare but is not deemed medically necessary for some reason, a recipient may need to sign a statement that they will pay for the service.

Summary of benefits
A summary of benefits is a simple list of services and benefits given to a recipient of healthcare by the provider. The list is in plain and simple terms, which makes it an easy document to review. As a result of the new healthcare law, all insurance companies are required to give their beneficiaries a summary of benefits. The purpose of the summary is to give customers the opportunity to review their healthcare options and compare services to make informed decisions by comparing services. The information is meant to be clear and concise to give seniors the necessary tools to understand their healthcare.

The Centers for Medicare and Medicaid Services describes the summary of benefits as a list that is similar to reading the nutrition facts on food labels. The comparison tool allows seniors to read examples of covered services and how the health insurance plan would apply. In general, the summary of benefits can not only provide a list of benefits, but also prove how valuable healthcare plans can be.

To maximize your Senior Health Insurance benefits, visit MySeniorHealthPlan.com for quick, simple and easy information.

2014-03-24T11:49:20+00:00 February 11th, 2014|Finance & Planning, Senior Health Insurance|Comments Off on What is a “Medicare Covered Service” and how to use my Summary of Benefits