Many folks on Medicare Advantage plans and other folks on original Medicare A & B with a Supplement (Medigap) are sometimes confused when a medical service is not covered by their plan. Medicare does cover almost everything on these plans; no matter which of these plans you have, they are all approved and are overseen by the Center for Medicare Services (CMS).
With Medicare Advantage plans you are on a network, and are required to use the doctors, labs, pharmacies, and hospitals in your network or risk not having your medical services covered. On these Advantage plans you will usually have co-pays but no monthly premium or medical deductible (this varies by region and county where your plan coverage is applicable). For example, if your doctor orders labs, make sure the lab they send you to is in your network or you risk paying for the entire lab bill instead of the small co-pay usually required.
With Medicare Supplements (Medigaps) you can usually go to any doctor or medical provider of your choice. Medicare receives the bill and pays their portion of the bill, then Medicare (not the medical provider) bills your Supplement (Medigap), and then your Supplement pays the balance of the bill. For the year 2020 there is a small annual $198 medical deductible for popular Plans G & N, but if you have a Plan F, Plan F also covers the medical deductible.
A word of caution, there is a very small 1% of medical providers called “Opt-Out”. If you use an Opt-Out doctor or medical facility, Medicare will not cover the procedure or visit. These facilities will inform you that they are Opt-Out and usually require you to sign a document stating you will be responsible for the entire bill.
Medical equipment is another area where folks get confused and, again, as long as you use your network or use a Medicare approved provider, you should not have any problems and just pay a co-pay with an Advantage plan. Medicare and a Supplement (Medigap) will usually cover the entire cost of medical equipment except for the annual $198 Medicare deductible. Beware that there are certain schedules with Medicare on exactly how often they will replace or repair your medical equipment.
We recommend that you always visit www.Medicare.gov and get details on what is covered and what is not. Simply enter your topic in the search bar at the top of the page and equipment items and medical procedure details will appear. You will find specific details on what is covered and how often. If you have a Medicare Advantage plan, simply call the customer service number on your member card and they will give you details on your plan’s co-pay coverage for equipment and services.