What is covered by Medicare?
Navigating your way through Medicare covered and non-covered expenses is an arduous task. In order to simplify this, a few rules must be established that are universally important to figure out coverage:
- Medical Necessity must be established- Care which a physician has determined to be certifiably essential for the diagnosis or treatment of a sickness or injury. This determination must be based on objective results produced by an examination of the covered person's demonstrable symptoms.
- Medicare Participating Provider- A licensed physician, hospital, skilled nursing facility or other provider authorized by the Medicare program to provide services or supplies. A Medicare participating provider agrees to accept Medicare Approved Amounts or MAA as payment in full for Medicare eligible expenses. Medicare participating providers accept Medicare assignment.
- Medicare Carrier: The term Medicare carrier means an agency or organization which has entered into an agreement with the United States Secretary of Health and Human Services to determine covered services and the amount approved as the basis for making payments; and make such payments as required by Medicare. Patients seeking services or procedures in a hospital, nursing home or home health care will have those services covered by Part A whereas services like mammography's, ambulance services, and skilled nursing facilities will have those services or procedures covered by Part B.
For your reference we have the following listings of Preventive Services and Screenings as well as a list of Equipment and Supplies with Medicare coverage's.