Dear Savvy Senior, Can you explain how Medicare covers concrete analysis services? I’m a new beneficiary, and would like to get some treatments for my back. — Charge Help
Medicare covers a array of outpatient analysis casework including physical, anatomic and accent therapy, if you accommodated their advantage criteria. Here’s how it works.
To get Medicare (Part B) to advice awning your concrete therapy, it charge be advised medically reasonable and necessary, and will charge to be ordered or assigned by your doctor.
You can get these casework as an outpatient at a cardinal of places like a doctor’s or therapist’s office, rehabilitation facility, medical dispensary or a hospital outpatient department.
You additionally charge to apperceive that Medicare banned how abundant it pays for outpatient analysis casework in one agenda year. These banned are alleged “therapy cap limits.” In 2017, Medicare will awning up to $1,980 for concrete and accent analysis combined, and addition $1,980 for anatomic therapy.
But be acquainted that aloof like with added Medicare covered services, Medicare will pay 80 percent (up to $1,584) of your analysis costs, afterwards you accommodated your $183 Part B deductible. You, or your Medicare added plan (if you accept one), will be amenable for the actual 20 percent until the cap banned are reached. Afterwards that, you’ll accept to pay the abounding bulk for the services.
If, however, you ability your cap banned and your doctor or therapist recommends that you abide with the treatment, you can ask your therapist for an barring so that Medicare will abide to pay for your therapy. The therapist charge accommodate affidavit that these casework are medically all-important for you to continue. If Medicare denies the claim, you can address through the Medicare appeals action — see Medicare.gov/claims-and-appeals.
If approved, Medicare has an barring beginning of $3,700 for concrete and accent analysis combined, and $3,700 for anatomic therapy. If your analysis bulk exceeds these thresholds, Medicare will analysis your case, which could advance to abnegation of added services.
If you accept to get concrete analysis on your own that’s not advised medically all-important or assigned by your doctor, your therapist is appropriate to accord you a accounting certificate alleged an “Advance Almsman Notice of Noncoverage” (ABN). Medicare Part B will not pay for these services, but the ABN lets you adjudge whether to get them.
Therapy at Home
You should additionally apperceive that Medicare covers home analysis casework too if you are homebound and acceptable to accept home bloom affliction from a Medicare-approved home healthcare agency. To apprentice added about this option, see the “Medicare and Home Bloom Care” online album at Medicare.gov/pubs/pdf/10969.pdf.
If you are enrolled in a Medicare Advantage plan (like an HMO or PPO), these affairs charge awning aggregate that’s included in aboriginal Medicare Part A and Part B coverage. But sometimes these affairs awning more, with added casework or an broadcast bulk of coverage. To acquisition out whether your plan provides added advantage or requires altered co-payments for concrete therapy, you’ll charge to acquaintance the plan directly.
If you accept added questions, alarm Medicare at 800-633-4227, or contact your State Bloom Insurance Assistance Program (SHIP), who provides free Medicare counseling in being or over the phone. To acquisition a bounded SHIP advisor visit Shiptacenter.org, or alarm the eldercare locator at 800-677-1116.
Send your chief questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and columnist of “The Savvy Senior” book.
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