Many people want to know how Original Medicare covers a particular health condition, treatment, service, and more. Fortunately for me, as an agent, and for you as a Medicare beneficiary, you can easily search on the Medicare.gov website.
For example, I will examine how Original Medicare covers kidney dialysis. First I go to medicare.gov. On the start page you will see a search field. Here you can enter the service for which you would like further information. Once I’ve entered Kidney Dialysis, I’ll click on “GO” and within a few seconds a list of services will appear, with dialysis services and supplies being the first. I’ll click on the link and get a detailed summary of the coverage. It handles inpatient care versus outpatient care, home dialysis training, support services, equipment and supplies, and certain home dialysis medicines covered by Original Medicare.
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In addition to a list of what is covered, is a brief mention of what is not. Medicare does not pay for treatment at home, no wages during self-dialysis training, accommodation during your treatment and blood or red blood cell concentrates for home dialysis, unless they are part of a medical service. The page then shows how much Medicare pays for the offered coverage, which in this case seems to be an 80/20 split for almost everything.
This is where Medicare supplements step to help you with outlays. As you can see, with Original Medicare, in addition to a supplement, your coverage will be quite extensive.
Medicare.gov also broadly explains 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 Medicare’s website, I think it’s done so well, and I urge you to explore it more!
Just as I discussed earlier with kidney dialysis, the Medigap guidelines fill the gaps in the coverage of Original Medicare for various services and treatments. For example, Medicare pays for the first 60 days of hospitalization (there is a deductible that must be met before paying anything), but from days 61-90 you pay co-insurance every day, which is $ 304 / day.
All Medigap plans cover this hospital donut hole, and that’s good news, because coverage will get worse the longer you stay in the hospital. Days 91-150 include a daily co-insurance of $ 608. A Medigap plan will cover this, and you do not have to worry about these gaps in coverage with Medicare. In fact, Medicare Supplement health insurance will cover up to an extra 365 days, which will help original Medicare cover!
A quick note: Lately, there have been stories in the news about labeling hospital patients as outpatients rather than inpatients and to make sure you know how you are classified. This is another important factor in whether Medicare covers the costs; How you are labeled can determine if Medicare will pay. Part A is paid if you are marked as inpatient and part B pays out if you are an outpatient.