Find out before the bills arrive

What Does Medicare Cover?

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It can be difficult to know what Medicare will and won't cover and how much your older adult will end up paying out of pocket.

Even if something is covered, your older adult will most likely have to pay a deductible or co-pay. That can really add up. It's best to estimate costs beforehand, so you'll be prepared when the bills arrive.

We explain how to find out if something will be covered, how to estimate costs for complex services, and how to get help understanding Medicare benefits.

How to find out if something is covered

In general, diagnostic tests (like x-rays or CT scans), preventive care check-ups, most surgeries, and hospital stays are covered.

Things like long term care, dental, and hearing aids aren't covered.

Use 3 steps to find out if something is covered:

  1. Ask the doctor or medical facility if they accept your older adult's specific Medicare plan for whatever is getting done (office visit, test, procedure, etc.).
  2. Go to this page on the website, enter the test or service, and click "Go" to search for it.
  3. Usually, the first or second search result will tell you if that item is covered and how much the patient will have to pay.

If the search doesn't show what you need, Medicare also provides an alphabetical list of various services and medical equipment that you can look through.

What Does Medicare Cover?

How to estimate costs for complex services

If your older adult needs something more complex like surgery, look it up to find further instructions on how to estimate those costs.

Generally, the costs will be based on:

  1. How much the doctor(s) and/or hospital will charge
  2. If your older adult has other insurance plans
  3. How much of their deductible remains

Additional information about Medicare coverage

The Medicare website also has helpful information about the different Parts of Medicare, preventive services, what to do in a disaster or emergency, and more.

Especially useful pages are:

Free state counseling programs are available

If you have trouble estimating costs for your older adult's medical care, we don't blame you. It's confusing. Take advantage of the free counseling available at the State Health Insurance Assistance Program (SHIP).

SHIPs are official state programs that help people understand their Medicare, Medicare Advantage, Medigap, and Medicaid benefits. Get more information about how these programs work and where to find your state's SHIP.

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