Traditional Medicare Benefits"Medical Necessity" is a term that has been used in recent years by Medicare and may not be familiar to you. "Medical Necessity" means that there are procedures and services physicians may prescribe for you that they may feel are necessary to manage your health. However, Medicare may not pay for certain services based up on their policies.
In the past, Medicare has covered most procedures. With the emergence of new technologies and other sophisticated and costly services and procedures, it is important for you to know what procedures and services will be covered by asking your physicians and or Medicare. We also encourage you to discuss with your physicians other treatment options available to you that may give them the information that they need to treat you. If your physician orders a procedure or service that Medicare may not cover, you may be asked to sign an Advance Beneficiary Notice (ABN). The ABN informs you in advance that Medicare are not likely to pay for the procedure or service, and that you will be responsible for payment. By signing the ABN, you are indicating that you understand and agree to be personally and fully responsible for payment.
Medicare beneficiaries are responsible for deductibles and co-insurance. If you receive services as an outpatient or in outpatient observation, you will be billed for non-covered oral drugs and some injectable drugs that fall under the category of Self-Administered. Please refer to the online version of National Medicare Handbook at www.medicare.gov or call 1-800-633-4227 if you need more information.
Hamlin Memorial does accept some Medicare Advantage plans. Medicare Advantage is a commercial insurance product and is not traditional Medicare. The Accountable Care Act will eventually de-fund the Medicare Advantage program. Many of our patients who are looking for pharmacy coverage are enrolled into a Medicare Advantage program at the same time. Please ensure that you know what program you are enrolling in. Medicare Advantage plans are not the best program for all patients.