Sunday, August 20 , 2017, 6:41 am | Overcast 64º

 
 
 
Your Health: A Noozhawk partnership with Cottage Health

David Sayen: What Medicare Does — and Doesn’t — Cover

Medicare helps pay for a wide variety of medical services and goods in hospitals, doctor’s offices and other health-care settings. But it doesn’t cover everything, and it’s useful to know what is and isn’t included.

Sayen
David Sayen

Services are covered either under Medicare Part A or Part B. If you have both Part A and Part B, you can get many Medicare-covered services whether you have Original Medicare or a Medicare health plan.

Part A is hospital insurance and it helps pay for:

» Inpatient care in hospitals

» Inpatient care in a skilled nursing facility (not custodial or long-term care)

» Hospice care services

» Home health care services

» Inpatient care in a religious nonmedical health-care institution

You can find out if you have Parts A and B by looking at your Medicare card. If you have Original Medicare, you’ll use this card to get your Medicare-covered services. If you join a Medicare health plan, in most cases you must use the card from the plan to get your Medicare-covered services.

Part B (medical insurance) helps cover medically necessary doctors’ services, outpatient care, home health services, durable medical equipment such as wheelchairs and walkers, and other medical services.

Part B also covers many preventive-care services.

Under Original Medicare, if the yearly Part B deductible ($147 in 2014) applies, you must pay all costs (up to the Medicare-approved amount) until you meet the Part B deductible before Medicare begins to pay its share.

After your deductible is met, you typically pay 20 percent of the Medicare-approved amount of the service, if the doctor or other health-care provider accepts assignment. (“Accepting assignment” means that a doctor or other provider agrees 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.)

You’ll pay more if you see doctors or providers who don’t accept assignment. And there’s no yearly limit on what you pay out-of-pocket.

If you’re in a Medicare Advantage plan (like an HMO or PPO) or have other insurance, your costs may be different. Contact your plan or benefits administrator directly to find out about the costs.

Under Part B, Medicare pays for many preventive services (such as screenings for cancer and heart disease) that can detect health problems early when they’re easier to treat. You pay nothing for most covered preventive services if you get the services from a doctor or other qualified provider who accepts assignment.

However, for some preventive services, you may have to pay a deductible, coinsurance, or both.

Medicare doesn’t cover everything, of course. If you need certain services that aren’t covered under Part A or Part B, you’ll have to pay for them yourself unless:

» You have other insurance (or Medicaid) to cover the costs.

» You’re in a Medicare health plan that covers these services.

Some of the services and goods that Medicare doesn’t cover are:

» Long-term care (also called custodial care)

» Routine dental or eye care

» Dentures

» Cosmetic surgery

» Acupuncture

» Hearing aids and exams for fitting them

— David Sayen is Medicare’s regional administrator for California, Arizona, Hawaii, Nevada and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 800.MEDICARE (633.4227).

  • Ask
  • Vote
  • Investigate
  • Answer

Noozhawk Asks: What’s Your Question?

Welcome to Noozhawk Asks, a new feature in which you ask the questions, you help decide what Noozhawk investigates, and you work with us to find the answers.

Here’s how it works: You share your questions with us in the nearby box. In some cases, we may work with you to find the answers. In others, we may ask you to vote on your top choices to help us narrow the scope. And we’ll be regularly asking you for your feedback on a specific issue or topic.

We also expect to work together with the reader who asked the winning questions to find the answer together. Noozhawk’s objective is to come at questions from a place of curiosity and openness, and we believe a transparent collaboration is the key to achieve it.

The results of our investigation will be published here in this Noozhawk Asks section. Once or twice a month, we plan to do a review of what was asked and answered.

Thanks for asking!

Click here to get started >

Support Noozhawk Today

You are an important ally in our mission to deliver clear, objective, high-quality professional news reporting for Santa Barbara, Goleta and the rest of Santa Barbara County. Join the Hawks Club today to help keep Noozhawk soaring.

We offer four membership levels: $5 a month, $10 a month, $25 a month or $1 a week. Payments can be made through PayPal below, or click here for information on recurring credit-card payments.

Thank you for your vital support.



 

Special Reports

Heroin Rising
<p>Lizette Correa shares a moment with her 9-month-old daughter, Layla, outside their Goleta home. Correa is about to graduate from Project Recovery, a program of the Santa Barbara Council on Alcoholism & Drug Abuse, and is determined to overcome her heroin addiction — for herself and for her daughter. “I look at her and I think ‘I need to be here for her and I need to show her an example, I don’t want her to see me and learn about drugs’,” she says.</p>

In Struggle to Get Clean, and Stay That Way, Young Mother Battles Heroin Addiction

Santa Barbara County sounds alarm as opiate drug use escalates, spreads into mainstream population
Safety Net Series
<p>Charles Condelos, a retired banker, regularly goes to the Santa Barbara Neighborhood Clinics for his primary care and to renew his prescription for back pain medication. He says Dr. Charles Fenzi, who was treating him that day at the Westside Clinic, and Dr. Susan Lawton are some of the best people he’s ever met.</p>

Safety Net: Patchwork of Clinics Struggles to Keep Santa Barbara County Healthy

Clinics that take all comers a lifeline for low-income patients, with new health-care law about to feed even more into overburdened system. First in a series
Prescription for Abuse
<p>American Medical Response emergency medical technicians arrive at Santa Barbara Cottage Hospital with little time to spare for victims of prescription drug overdoses.</p>

Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

Evidence of addiction shows an alarming escalation, Noozhawk finds in Prescription for Abuse special report
Mental Health
<p>Rich Detty and his late wife knew something was wrong with their son, Cliff, but were repeatedly stymied in their attempts to get him help from the mental health system. Cliff Detty, 46, died in April while in restraints at Santa Barbara County’s Psychiatric Health Facility.</p>

While Son Struggled with Mental Illness, Father Fought His Own Battle

Cliff Detty's death reveals scope, limitations of seemingly impenetrable mental health system. First in a series