Part A

If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules. Your plan must give you at least the same coverage as in the original Medicare plan you deserve. Some services may only be covered in certain settings or for patients with specific conditions.

Two ways to find out if Medicare covers what you need

  • Talk to your doctor or other health care provider about why you need certain services or supplies. Ask if Medicare will cover them. You may need something that‘s usually covered but your provider thinks that Medicare won’t cover it in your situation. If so, you’ll have to read and sign a notice. The notice says that you may have to pay for the item, service, or supply.

Medicare coverage is based on 3 main factors

  • Federal and state laws

  • National coverage decisions made by Medicare about whether something is covered.

  • Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.