Not sure what Medicare covers? We explain how to find out if something will be covered by Medicare, how to estimate costs for complex services, and where to get help understanding Medicare benefits.

Avoid Surprise Bills by Knowing What Medicare Covers

Because Medicare is so complex, seniors can end up getting blindsided by huge medical or prescription medication costs.

That’s why it’s important to figure out what Medicare will cover, what counts toward the deductible, what the co-pay will be, and how much will be paid out of pocket.

Estimating costs ahead of time means everyone will be better prepared when the bills arrive.

Even if you are in your 50s, knowing what Medicare covers is important to know if you have to help choose an older adult’s healthcare and prescription drug plans for the year. Being able to estimate costs ahead of time steers you toward plans that maximize coverage and minimize expenses.

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

What Does Medicare Cover? How To Find Out

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.

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, item, procedure, etc.
2. Go to this page on the Medicare.gov website, then 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.

How To Estimate Costs for Complex Services

If you or your older adult needs something more complex like surgery, look it up and also review the additional instructions on how to estimate those costs.

Generally, 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

Get 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:

• Find a doctor, hospital, facility, or plan that accepts Medicare
• Find local shops that sell covered medical equipment and supplies
• Which drugs are covered by which drug plans (click the link at the bottom)

Free State Insurance Counseling Programs Are Available To Help

If you have trouble estimating costs for medical care, you’re not alone – it can get confusing.

Take advantage of the free counseling available through the State Health Insurance Assistance Program (SHIP).

SHIP are official state programs that help people understand their Medicare, Medicare Advantage, Medigap, and Medicaid benefits.

Get more info about how these programs work and where to find your state’s SHIP.

This article originally appeared on DailyCaring.com.

• What You Should Know about Medicare Before Age 65
• Medical Expenses Medicare Doesn’t Cover
• 5 Options for Medications Not Covered by Medicare
• How to Avoid Medicare Mistakes

Reviewed March 2024

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