Medicare Patients:
1 min
65 OR OLDER, DISABILITY:
TRADITIONAL MEDICARE, HUMANA, AARP, UNITED HEALTHCARE SECURE HORIZONS, AETNA MEDICARE HEALTHTEAM ADVANTAGE, MEDICARE CIGNA
MEDICARE ONLY PAYS FOR THE ADJUSTMENT-NOTHING ELSE!
Medicare does NOT cover the following:
- Exams, Re-Exams, XRays and Therapies
ADJ: $ _________ + THF ($20) ALWAYS UNLESS THEY CHOOSE NOT TO DO THERAPY
THERE IS A SHEET THEY SIGN TO NOTIFY THEM OF THE NON-COVERED SERVICES (ABN)
SUPPLEMENT 1: COVERS DED + CO INS (ADJ: $0)
SUPPLEMENT 2: ONLY COVERS CO INS (STILL RESPONSIBLE FOR DEDUCTIBLE)
TRUE SECONDARY- MAJOR MEDICAL ON TOP OF THEIR MEDICARE - COVERS ALL THERAPIES, PATIENT DOESN'T PAY ANYTHING OUT OF POCKET (RARE)
Medicare Advantage Plans:
- Medicare advantage plan is NOT traditional Medicare
- Examples: UHC Medicare Advantage, Humana Gold/PPO
- Verify benefits like commercial Insurance
- check: Copay, Visit Limits and Authorization required
IMPORTANT
- Medicare ONLY cover ACTIVE TREATMENT (AT)
- Maintenance care is NOT covered
- Medicare deductible resets every calendar year
- Patients may owe more at the beginning of the year
- If supplement is on file: Medicare usually automatically forwards (crosses over)
- If not: May need to manually bill secondary
Quick Reference Checklist
- ☐ Medicare vs Advantage confirmed
- ☐ Coverage type verified
- ☐ ABN signed (if needed)
- ☐ Supplement checked
- ☐ Deductible status reviewed
- ☐ AT modifier applicable
- ☐ Patient financial responsibility explained