Medicare and Insurance Guide

If you are wondering whether you qualify for Medicare benefits, read on to find out more in this comprehensive guide.

Who Qualifies for Medicare?

If you meet one or more of the below criteria, you qualify for Medicare benefits:

• You are 65 years or older.
• You have permanent kidney failure.
• You have a permanent disability and are eligible for Social Security benefits.

Different Tiers of Medicare

Depending on your circumstances, you may qualify for one or more tiers of Medicare:

• Medicare Part A: You are entitled to inpatient hospital stays, hospice services and homecare under Part A. No monthly fee is required in most cases; patients only pay when they use the services.
• Medicare Part B: Doctor consultations, lab tests, home equipment and ambulance services are covered under Part B. Typically, recipients of Part B benefits have to pay a monthly premium to stay enrolled, even if they have not used the services in that month. This amount will vary based on your income level.
• Medicare Part C: Part C is offered as an alternative to Part B by various insurance companies with Medicare Advantage plans. The same services are covered under Parts B and C, but with Part C, there are limited service providers and authorization may be required for services before payment can be made.
• Medicare Part D: Part D is an additional and optional benefit that covers prescription drugs.

Cost of Medical Equipment

Medicare will only cover the most basic medical equipment for your needs, but you have the option of upgrading to a more advanced version if you are willing to cover the difference. To this end, you will be required to sign an Advanced Beneficiary Notice of Non-Coverage form (ABN), indicating your agreement to pay for the difference between the two items. This allows your supplier to allocate the sum of the basic product towards the product you want.

Understanding the ABN

Besides allowing you to upgrade to better equipment, ABNs also serve the purpose of notifying you beforehand if Medicare will not pay for a particular product or service, and why. This reason will take into consideration your personal circumstances and explain clearly why you are not entitled to coverage. In such a scenario, the ABN allows you to make an informed decision whether you would like to go ahead with the treatment or product with the knowledge that it will not be covered by Medicare.

When is Medical Equipment Covered?

Most often, Medicare will only pay for medical equipment that meets the below criteria:

• Can be used repeatedly, excluding disposable items such as diapers.
• Is used to improve a medical condition, in which case an underlying condition must be present.
• Will serve no purpose in the absence of illness and/or injury. This excludes preventative items such as anti-slip bathroom mats.
• Can be used in the home.

Find Out If You Qualify for Medicare

If you are unsure whether you qualify for Medicare benefits, please visit the Medicare website for more information.