Part A, Part B, Part C, Part D, Medicare Advantage - You've almost finished your ABCs! Do the different Medicare elements confuse you?

Part B covers things like clinical research, ambulance services, durable medical equipment (called DME), mental health (inpatient, outpatient, partial hospitalization), and limited outpatient prescription drugs.

-Foundation for Financial Wellness

Video Transcript

Medicare coverage is based on 3 main factors:

1. Federal and state laws.

2. National coverage decisions that are made by Medicare about whether something is covered.

3. Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.

Part B covers two types of services:

1. Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practices.

2. Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

You pay nothing for most preventive services if you get the services from a health care provider who accepts what they call “assignment.” “Assignment” is an agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.

Part B covers things like clinical research, ambulance services, durable medical equipment (called DME), mental health (inpatient, outpatient, partial hospitalization), and limited outpatient prescription drugs.

Two ways to find out if Medicare covers what you need:

1. Talk to your doctor or other health care provider about why you need a certain service or supplies. Then ask if Medicare will cover those. You may need something that's usually covered, but your provider thinks that Medicare won't cover it in your situation. If so, then you'll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply yourself.

2. To find out if Medicare covers your item or service, remember go back to www.medicare.gov/coverage and find out yourself. Lastly, a noteworthy point to make - If you're in a Medicare Advantage Plan or other Medicare plan, your plan may have different rules. But, your plan must give you at least the same coverage as Original Medicare. Some services may only be covered in certain facilities or for patients with certain conditions.

Now to our review - Do you have any decisions to make or actions to take?

I would say number one, begin compiling questions you want to ask your Medicare professional. Two, keep that website address in your notes, www.medicare.gov/coverage to see if Medicare covers any specific item.

As always, don’t forget, you can also always to take advantage of your private counseling session for these topics. It’s included, it’s private, it’s confidential and it’s always with one of our Certified Financial Wellness Counselors. To schedule your counseling session, simply click on the "Request Counseling" button.