As an agent you would think you’ve seen or heard it all, but someone every so often will still throw a curveball at you regarding their chronic conditions.
When I think of all these questions that Medicare recipients always ask, I ask them in return “Do you really know what all your rights and entitlements are under Medicare?” or “When was the last time you sat down with a licensed professional to ask these important questions?”
This is the reason why I always put emphasis on seniors sitting down with a BGA insurance agent and getting the correct information on these very important issues.
Without getting into the details of Medicare A & B and what it covers, we know you are covered about 80% for hospitalization and medical. But what about medical equipment?
Where does all that fall in under Medicare?
“Durable medical equipment” is covered under Medicare Part B.
Wait! That all depends if you have a Medigap plan to supplement your Original Medicare. If you have a Medicare Advantage plan you could have restrictions and higher costs associated.
Examples of durable medical equipment could be wheelchairs, crutches, oxygen and accessories, traction equipment, a hospital bed for your home, diabetic supplies, walkers and braces.
These are just a few items that fall under the medical equipment term that are covered for as long as it is PRESCRIBED by a licensed physician if you have Original Medicare.
Basically, if you are prescribed a piece of medical equipment that is necessary your Original Medicare will pay 80% and your Medigap (supplement plan) will pay the other 20%, the Part B deductible applies. This also applies if you are given a medication at the hospital, outpatient facility or a physician’s office.
Now, if you are a Medicare Advantage (HMO, PPO) policy holder you will want to ask some questions. Yes, your plan must cover and match what Original Medicare covers up to 80% but you will have some costs associated with the remaining 20% which could be expensive.
What are those costs? That depends what plan you have with what insurance carrier administers the plans benefits. I’m going to again reiterate every BGA agent specializes in both Medigap and Medicare Advantage plans so don’t hesitate to ask us those questions.
Where can I get durable medical equipment if I need it?
If you’re enrolled in Original Medicare, you must obtain your durable medical equipment from a supplier that is enrolled in the Medicare program, or Medicare will not cover the equipment.
For the lowest costs, find suppliers that are “participating,” which means they accept the Medicare-approved cost for the equipment and will not charge you above that amount. To find Medicare-participating suppliers, visit the Medicare.gov Supplier Directory.
“All Medicare contract suppliers need to meet special Competitive Bidding Program requirements, federal quality standards, and state licensure requirements. They also need to be in good standing with Medicare and be accredited by an Independent Accreditation Organization.”
I want to once again speak about cancer drugs such as chemotherapy where you would go to a medical facility to have it administered. I bring this up constantly because a lot of Medicare Advantage policy holders are not up to date on this issue and could cost themselves a lot of money.
If you need any specialty drug administered at a facility for example chemo, you would be covered up to 80% and in most cases would have to pay the remaining 20% costs. I ask you to reach out to a BGA agent to either inquire about a Medigap policy or a very inexpensive cancer policy to cover those costs.
The average 65 to 70 could purchase a $5000 cancer benefit for about $18 a month. $18 a month could save you your life savings. If you are covered under Original Medicare with a Medigap plan you are covered for the remaining 20% costs, of course the Part B deductible applies.
At the very least if you have no interest in supplementing your existing coverage, at least start the conversation to get the answers you need.
One last thing, it’s July and I get it, Medicare is not on your mind right now. October will be here before you know it, don’t let another year escape you. A lot of new important Medicare information will be available for the Annual Enrollment Period this October and BGA Insurance Group is ready to assist you.
For more information on what is covered, please refer to our FAQ that covers Parts A B C D.
Joe Bachmeier is a co-founder of BGA Insurance Group