What will my Medicare, Medicaid, and/or Private Insurance cover?

With all the healthcare changes happening, it is easy to get lost when trying to decipher the coverage.  The questions we get most often in the world of medical supplies are a version of:

-Will my Medicare cover it? 

-Will my Medicaid cover it? 

-Will my Insurance cover it?

Most often, if a doctor will write a prescription for it, your type of health insurance will cover it, be it Medicare, Medicaid, or a private insurance.  For each kind of insurance, there are strict rules about what they will pay for.  More often than not, there will be some out of pocket expense in the form of a co-pay.

Medicare is the government’s elderly insurance program, with some exceptions such as life-long disabilities.  It pays 80% of covered items such as catheters, diabetic testing supplies, and ostomy products with a doctor’s prescription and medical records on file.  The remaining 20% must be paid by a secondary insurance or out of pocket. Medicare does not cover adult incontinence products such as pads, pull-ups, or diapers.  They also do not cover bathroom safety products such as transfer benches, commode lifts, or bath rails.  Products such as scooters, wheelchairs, and canes are covered but they have strict time-frame limits meaning one can only be covered every few years.  In order to truly know what your Medicare will and will not cover, you should visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227).

Medicaid is each state’s insurance program covering children 18 and under, and those who can not economically meet the costs of their medical supplies.  Each state’s Medicaid coverage varies so you will want to check.  www.Medicaid.gov provides each state’s Medicaid office information.  Those offices will be able to help you with enrollment as well as tell you what will be covered.  In Arkansas, for example, Medicaid covers incontinence supplies 100% for ages 3 to adult with a prescription from the doctor and a patient’s medical necessity.  Generally, Medicaid offers wider coverage of products, but has restrictions on the cost of those products it will cover limiting selection somewhat.

Private insurance can be secondary to Medicare, primary to Medicaid, and the sole payer, so the coverage amount varies widely.  It is best to contact your private insurance provider about what they will pay for, reimburse for, etc before making any purchases of medical supplies.  Like with Medicare and Medicaid, a doctor’s prescription and medical records will probably be necessary.

POSTED ON: August 30 2012
Posted by:Su-Lauren Wilson owner,CFO
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