We are new to medicare. My wife ages in next week several months before I will. So we signed her up with a Cigna plan G ($90)and a SilverScript Choice ($17+ copays)for drugs. This combination seems to be fairly comprehensive and is within our budgets. Wondering what the potential pitfalls are as it relates to coverage. Are there tests or procedures that medicare might refuse to pay for? I don't want to get stuck paying for something not knowing if it's covered or not. Any suggestions from folks who have been down this path already?
Medicare Information and Discussions
Independent Community Helping you to Understand Medicare
What Does Medicare Exclude?
- Thread starter Davidg
- Start date
It is impossible to predict what tests you or your wife might need in the future. Medicare does not cover every possible test or procedure, but does cover the most reasonable and accepted tests and procedures. You didn't mention whether or not you or your wife had any medical issues. I would say that unless you had current special medical issues that you will probably be fine. You can always change the Part D Drug program once a year without penalty during open enrollment if you find the current plan is no covering the meds you are taking.
The website below lists common services not covered by Medicare. It also has a link at the bottom of the webpage. Clicking on that link allows you to search for items that may/may not be covered. Also, a procedure may be covered for certain diagnosis but not others. Preventive services have limitations on how often you can obtain them.
https://www.medicare.gov/what-medic...and-services-not-covered-by-part-a-and-b.html
If a service may not be covered by Medicare, you will be asked by the provider in advance to complete an 'Advance Beneficiary Notice' (ABN). This also gives you a warning that you may want to ask more questions before obtaining the service as the ABN allows the provider to bill you for non-covered services.
More info on ABN: https://www.medicare.gov/claims-and-appeals/medicare-rights/abn/advance-notice-of-noncoverage.html
I agree with reviewing the Part D plans available each year even if your medications do not change.
https://www.medicare.gov/what-medic...and-services-not-covered-by-part-a-and-b.html
If a service may not be covered by Medicare, you will be asked by the provider in advance to complete an 'Advance Beneficiary Notice' (ABN). This also gives you a warning that you may want to ask more questions before obtaining the service as the ABN allows the provider to bill you for non-covered services.
More info on ABN: https://www.medicare.gov/claims-and-appeals/medicare-rights/abn/advance-notice-of-noncoverage.html
I agree with reviewing the Part D plans available each year even if your medications do not change.
Last edited: