FAQ: Probate & Estate Administration

What is Medicare?

What is Medicare?

Medicare is a federal government program that helps older folks and some disabled people pay their medical bills. The program is divided into two parts: Part A and Part B. Part A is called hospital insurance and covers most hospital stay costs, as well as some follow-up costs. Part B, medical insurance, pays some doctor and outpatient medical care costs.

What kinds of costs does Medicare Part B cover?

Part B medical insurance is intended to help pay doctor bills for treatment in or out of the hospital. It also covers many medical expenses you incur when you are not in the hospital, such as the costs of necessary medical equipment and tests and services provided by clinics and laboratories.

The lists of services specifically covered and not covered are long, and do not always make a lot of common sense, but making the effort to learn what is and is not covered can be important. You may get the most benefits by fitting your medical treatments into the covered categories whenever possible.

Part B insurance pays for:

• doctor services (including surgery) provided at a hospital, a doctor's office, or your home
  
  
• mammograms, pelvic exams, bone density tests, and PAP smears for women
  
  
• an annual flu shot
  
  
• a one-time physical exam (called a "wellness exam") done within six months of when you enroll in Medicare Part B
  
  
• medical services provided by nurses, surgical assistants, or laboratory or X-ray technicians
  
  
• outpatient hospital treatment, such as emergency room or clinic charges, X-rays, injections, and lab work
  
  
• an ambulance, if required for a trip to or from a hospital or skilled nursing facility
  
  
• drugs or other medicine administered to you at a hospital or doctor's office (for other drugs, Medicare currently offers drug discount cards, until 2006 when it will begin providing partial drug coverage)
  
  
• medical equipment and supplies, such as splints, casts, prosthetic devices, body braces, heart pacemakers, corrective lenses after a cataract operation, glucose monitoring equipment, and therapeutic shoes for diabetics, and equipment such as ventilators, wheelchairs, and hospital beds
  
  
• some kinds of oral surgery
  
  
• some of the cost of outpatient physical and speech therapy
  
  
• a limited number of services by podiatrists and optometrists
  
  
• some care and counseling by psychologists, social workers, and daycare personnel
  
  
• some preventative screening exams, such as for cancer, glaucoma, and osteoporosis; as well as diabetes and heart disease, but only if your doctor says you're at risk for them
  
  
• manual manipulation of out-of-place vertebrae by a chiropractor
  
  
• Alzheimer's-related treatments
  
  
• scientifically proven obesity therapies and treatments, and
  
  
• part-time skilled nursing care, physical therapy, and speech therapy provided in your home.

How much of my bill will Medicare Part B pay?

When all of your medical bills are added up, you will see that Medicare pays, on average, only about half the total. There are three major reasons why it pays so little.

First, Medicare does not cover a number of major medical expenses, such as routine physical examinations, medications, glasses, hearing aids, dentures, and a number of other costly medical services.

Second, Medicare pays only a portion of what it decides is the proper amount -- called the approved charges -- for medical services. When Medicare decides that a particular service is covered, it determines the approved charges for it. Part B medical insurance then usually pays only 80% of those approved charges; you are responsible for the remaining 20%.

Note, however, that there are now several types of treatments and medical providers for which Medicare Part B pays 100% of the approved charges rather than the usual 80%. These categories of care include home health care, clinical laboratory services, and flu and pneumonia vaccines.

Finally, the approved amount may seem reasonable to Medicare, but it is often considerably less than what doctors actually charge. If your doctor or other medical provider does not accept assignment of the Medicare charges, you are personally responsible for the difference.

Copyright © 2005 Nolo

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

View Previous Months' Selections