How to Find out What Medicare Pays for Medical Procedures, Supplies, Tests and Other Items

Medicare Procedure Costs and Coverage

If you're on Original Medicare, check your costs before you get a procedure

If you’re “bare with Medicare” or – are on Original Medicare with no Medicare Supplement or Medicare Advantage plan and you’re facing an upcoming surgery or other procedure, you may be wondering how much of the cost Medicare will pay. Knowing what you can anticipate in terms of coverage can help you to plan where and when your services are received. It can also allow you to prepare for any out-of-pocket costs that will fall to you.

When it comes to Medicare coverage, there can be a myriad of different factors that determine what Medicare will and won’t pay for, and how much of the cost responsibility you’ll be required to share.

For instance, in some cases, the amount of coverage – if any – that you receive for an item or service will be dependent on where you live. There is, however, a long list of tests, items, and services that are covered regardless of your address. These can be found by going directly to Medicare’s website by clicking here and then clicking on the specific link.

For example, by clicking on the link for Foot Exam, you will find that Medicare Part B covers a foot exam every six months, provided that you have not seen a foot care professional for another reason between visits.  You will also find that, in order to be eligible for this coverage through Medicare, you will have to have been diagnosed with diabetes, diabetic peripheral neuropathy, and/or loss of protective sensations.

Out-of-Pocket Expenses to Keep In Mind

Even if Medicare picks up the tab for your items and / or services, it is important to keep in mind that you will oftentimes still be responsible for various out-of-pocket charges such as deductibles, copayments, and / or coinsurance.

The specific amount that you owe for your Medicare-covered items and services can also be dependent on how much your doctor charges, whether or not your health care provider accepts Medicare assignment, where you get your test, item or service, and any other insurance coverage that you have.

For instance, many people who are enrolled in Original Medicare (which is Medicare Part A and Part B) are eligible to purchase a Medicare Supplement insurance plan. These plans can provide coverage for some – or possibly even all – of your out-of-pocket Medicare-related charges.

Where to Learn More About How Much Medicare Pays

In order to learn more about how much Medicare may pay for your item, test, or procedure, you can go directly to the Medicare website at: www.Medicare.gov, and then click on the “Forms, Help & Resources” tab. You can also fill in the name of your upcoming test, item or service in the “Is my test, item, or service covered?” on the lower right-hand area on the webspage.

Likewise, talking with someone who is an expert in the Medicare area such as a really good independent insurance agent can be beneficial in determining your potential coverage and costs, as well as for learning more about your Medicare coverage in general.