The East Community Guide - Gainesville, FL October 2018 | Page 5

Part B covers 2 types of services
 Medically necessary services: Services or supplies that are
needed to diagnose or treat your medical condition and that
meet accepted standards of medical practice.
 Preventive services: Health care to prevent illness (like the flu) or
detect it at an early stage, when treatment is most likely to
work best.
You pay nothing for most preventive services if you get the services from a
health care provider who accepts Assignment.
Part B covers things like:
 Clinical research
 Ambulance services
 Durable medical equipment (DME)
 Mental health
 Inpatient
 Outpatient
 Partial hospitalization
 Getting a second opinion before surgery
 Limited outpatient prescription drugs
2 ways to find out if Medicare covers what you need
1. 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.
2. Find out if Medicare covers your item, service, or supply.
Medicare coverage is based on 3 main factors
1. Federal and state laws.
2. National coverage decisions made by Medicare about whether
something is covered.
3. 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.
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