Original Medicare helps cover medically necessary hospital and medical services. However, many people think Medicare will cover all costs, but that is not true. There are deductibles with Part A and Part B and coinsurance that you are responsible for paying. Additionally, there is no cap to your expenses with Medicare which can be financially devastating.
Medicare beneficiaries can enroll in a Medigap plan to help with those costs. Medigap plans will be secondary to Original Medicare and cover costs after Medicare pays first. One of the most comprehensive plans is Medicare Plan G. The only out-of-pocket cost you have is the Part B deductible. If you’d like to read reviews on Plan G to see if it might be a good fit for you, you can visit boomerbenefits.com/medicare-plan-g-reviews.
Medigap Plan G must cover what Medicare covers. Keep reading to learn about different services that Medicare covers.
Preventive Services Covered by Medicare
Medicare covers several preventive visits. These services are covered 100%. Therefore, you should not pay anything for these services as long as you fit within their guidelines.
- Bone density measurements every two years
- Cervical cancer screening every five years
- Heart disease screening with blood tests every five years
- Prostate cancer screening every year
- Screening mammogram every year
Medicare may pay the total cost of these services if you are at high-risk and need the service completed more frequently than the above timeframes.
Whether you need to go to the emergency room or urgent care, Medicare Part B will cover 80% of your visit if the facility accepts Original Medicare. If you have a Medigap Plan G, your Plan G will help cover the remaining 20% once you’ve satisfied the deductible.
If you ever wonder which one you should go to for certain situations, you can think of the emergency room for life-threatening injuries or illnesses. If the injury or disease is causing severe bodily harm or could potentially be fatal, you may consider the ER over the urgent care.
Urgent care is typically used for less threatening injuries or illnesses. You’ll likely have a lower bill, and the wait time might not be as long as an ER visit, but they typically don’t deal with life-threatening situations. Either way, Medicare should cover medically necessary services.
Durable Medical Equipment
Durable medical equipment (DME) is covered under Medicare Part B. DME is equipment that helps benefit the patient who has a specific illness or condition. Since DME is covered by Part B, the deductible and coinsurance could apply, but if you had a Plan G policy, it would cover the coinsurance for you.
Everyday DME items include:
- Wheelchair and power mobility devices
- Infusion pumps and supplies
- External insulin pumps and the insulin
- Nebulizers and the solution used in them
- Neck, back, and leg braces
- Sleep apnea devices
You will likely need a prescription or written order from the doctor for Medicare to cover it. Additionally, you will want to get your DME from a Medicare-approved supplier. Medicare may require specific things depending on the DME item, so you will want to speak with your provider and the supplier to ensure you have everything you need.
Medicare Part B also covers vaccinations. Vaccinations that fall under Part B are covered 100% by Part B. These vaccines include:
- Flu vaccine
- Pneumonia vaccines
- Hepatitis vaccine
- Covid-19 vaccine
- Covid-19 boosters
You will want to speak with a healthcare professional to know more about the timing between vaccines and which ones you may consider getting.
Medicare Part A and Part B cover medically necessary services needed to treat, diagnose, or monitor a health condition. Additionally, Medicare covers several preventive visits. If you have a Medigap plan, it will help cover costs after Medicare pays. If you have an Advantage plan, the plan must offer the same benefits that you’d receive from Part A and Part B, but your cost-sharing may vary.