Medicare Coverage IS NOT An Even Playing Field

Most people assume that since Medicare is a national program that it covers the same services for all Medicare constituents regardless of residence. That is not true. Medicare coverage varies by region and by Medicare plan. For instance Transcranial Magnetic Stimulation is covered by Medicare in 11 states, but not the rest. That is too bad because TMS is an effective noninvasive treatment for depression with far fewer side effects than ECT. However if you are over 65 and live in one of the 39 non covered states ECT is the only option Medicare will pay for.

A similar situation exists for lab testing. Often we get asked why Medicare covered a certain lab test , such as MMP-9, for a patient last year, or for their friend this year, but not for them. The answer, which is not broadcast in open enrollment season, lies in the fact that most people chose a Medicare plan that is “managed” by an insurance company, such as Health Net or United. Often the company makes their profit by “saving” Medicare money – that is by denying your claims. In general, as the following article details, most people are best off, in terms of coverage, by choosing a complete program that deals with Medicare directly.

Beware of Shifting Options within Medicare plans

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ORIGINAL OR ADVANTAGE? Some consumer advocates favor using traditional Medicare with a supplemental plan, largely because it is more predictable and you are free to see any doctor who accepts Medicare.

That is what Mr. Baker said he would recommend for his own grandmother. “I would say enroll in original Medicare and let’s get you the Medigap plan you might need when you are older or sicker,” he said. “If you are in original Medicare and you have a Medigap plan, you are pretty much set for life if you are happy with those things.”

If you are contemplating switching from Medicare Advantage back to original Medicare — and you want to buy a supplemental policy — that is something you may want to do while you are younger and healthier. Later on, coverage may become more expensive or you can be denied altogether. With some exceptions, individuals are guaranteed coverage only if they buy it during a special period six months after their 65th birthday. During that time, insurers cannot refuse to sell you a policy because of a pre-existing condition or other medical issue, nor can they charge you more.

Mary Ackerley, MDMary Ackerley MD, MD(H), ABIHM is a classically trained psychiatrist and homeopathic physician who specializes in the holistic treatment of depression, anxiety, bipolar disorders, digestive disturbances and hormone replacement therapy.

She can be reached through her clinic MyPassion4Health at 520-299-5694 or online at