Answer:

Original Medicare covers many tests, items, and services (see a list of covered tests, items, and services). You can also check any Advantage or Drug plan’s formulary for a list of covered drugs.[1]

You can also check your Advantage plan’s benefits to see cost-sharing and other factors like if authorization is required and if prices are different in-network and out-of-network for service categories.

Beyond that, and this is especially true when you want to access an item or service, you, a representative, or your provider can request an organization determination to determine if authorization is needed, the amount you’ll pay, or limits on an item or service. If the plan won’t cover an item or service, they must tell you in writing.

TIP: When in doubt, if you want to know if something is covered, simply call your insurer and ask.

Citations

  1. Is your test, item, or service covered? Medicare.Gov.

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