Medicare

A doctor tells you that you may need a test or procedure done and, after leaving the office, you begin to worry if that test is covered under your Medicare plan.  This is a worry for everyone but especially for new people coming into Medicare.  Having seen many things denied, or having gotten into a fight with their commercial insurance company prior to joining Medicare,  it is understandable that this worry comes up.  Did you know that there is a Medicare app called “What’s Covered?” that is available on both the Apple Store and Google Play?

This app allows you to search procedures and tests already listed in their database and allows you to type in procedures by name.  It also covers preventive services and the frequencies in which you may have them done.  Some services do require your Medicare participating physician to get a pre-authorization before the service is done.  It never hurts to make sure they have done so.

As for coverage with your Medicare Supplement Plan – if Medicare covers the service and has pre-authorized it for you (again check with your doctor) then your Medicare Supplement plan must also pay the remaining balance.  The Supplement cannot say “No!”, to a Medicare approved service.

If you are covered under a Medicare Advantage plan, this application won’t be accurate for you.  While you are still part of the Medicare system, it is up to the commercial insurer who offers you coverage under the Part C Medicare Advantage Plan, whether it will be covered or not.  In that case always check with your physician and your insurer if you have any questions on whether a test or procedure is covered and how it will be covered.