Staying On Top Of Medicare Coverage

by Kim Keller

We found a terrific resource on the Medicare website that will quickly tell you what costs Medicare will cover and what costs it won’t.

The Medicare Coverage Database is simple to use.  You can either enter your Medicare policy ID number or you can select, from the respective drop-down menus, the appropriate state and coverage topics, which includes everything from occupational therapy to mental health care to surgical services to heart, lung, kidney, pancreas and liver transplants — it’s a huge list of options.

Then simply click View Results.  It’s that easy.

You’ll receive guidelines outlining the requirements for coverage, such as whether a doctor needs to approve the treatment, what percentage of the bill you’ll be responsible for, and who else you can contact for additional information.  The database explains the coverage situation for items such as hearing aids and wheelchairs; for tests like mammograms and blood screenings; and for services like surgery and emergency room visits.  It is a thorough database with easily accessible information.

Did you know, for example, that you can run out of hospitalization coverage?

My mom and sister and I were aware that rehabilitation after a hospital stay had limits, but we were unprepared for our dad’s running out of hospitalization coverage.  He had been in and out of various hospitals and rehabs when Mom got a call one day from the hospital business office.  “Your husband ran out of hospitalization coverage 16 days ago,” stated the hospital representative matter-of-factly.

I think Mom’s “WHAAAAT?!!” could be heard in the next county.

Hospitalization and rehabilitation coverage is limited to a certain number of days in what Medicare calls a “benefit period.”  For example, the benefit period for rehabilitation after a hospital stay is 100 days.  To regenerate a new term of 100 days, a patient is required to be free of hospital or skilled-nursing care (Medicare’s term for rehab) for 60 consecutive days.  After 60 days without hospital and/or skilled-nursing care, Medicare provides a fresh 100 days of coverage.

This is a convoluted mathematical arrangement that sometimes causes more trouble than it solves, as it did with our dad who was too sick to be without care for 60 consecutive days.  But until Medicare gets around to adjusting these numbers, it’s far better to be aware of — and prepared for — the agency stipulations than to find yourself suddenly surprised by them.

If you want to learn more about Medicare basics, explore the coverage database and also check out the In Care of Dad article, “Understand How Medicare Works.”

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