Does Medicare Pay or Not?

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Do you know what Medicare covers? Do you know what it doesn’t pay for?

David Sayen is a Medicare regional administrator for several Southwest US states. He recently wrote an article which broke down what Medicare did and did not cover.

Services are covered under Medicare Part A and Part B.

Part A is Hospital and helps pay for:

Inpatient care in hospitals
Inpatient care in a skilled nursing facility (but not custodial or long-term care)
Hospice care services
Home health care services
Inpatient care in a religious, non-medical health care institution.

Part B also covers many preventative-care services.

If the yearly Part B deductible ($147 in 2014) applies, you must pay all the costs up to the Medicare-approved amount. Once you meet the Part B deductible, Medicare will begin to pay its share.

After the deductible is met, you will typically pay 20% the Medicare-approved amount if the doctor or health care provider accepts “assignment”. This means that the doctor or other provider agrees to be paid directly by Medicare, to accept the payment amount Medicare approves, and not to bill you for any additional amount.

There’s no yearly limit as to what you pay out-of-pocket.

Part B Medicare also pays for many preventative services such as cancer screenings and heart disease. You may pay nothing if an assignment is accepted. However, you may be charged a deductible, coinsurance, or both for some preventative services.

If you’re in a Medicare Advantage plan (HMO or PPO), your costs may be different and you will need to contact your benefits administrator to find out what those costs are.

Some services and goods that Medicare will not pay for are: