Does Medicare Require Pre-Approval for Procedures?

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This is a commonly asked question regarding Medicare and pre-approval for procedures, surgeries, etc. What this means is that you must contact your insurance provider (in this case, Medicare) prior to getting any significant procedure/surgery to discuss it with them and get it pre-authorized. While many under-65 health plans do require this, it is important to understand that Medicare does not mandate pre-approval for procedures or surgeries.

On the contrary, with Medicare, you do not have to contact them in advance of any service or procedure. Now, your doctor’s office or hospital may require something from you in advance – typically, they will require proof of insurance and verify that you are covered and have insurance in place to cover a portion of your expenses.

Likewise, you do not have to get pre-approval from a Medigap company to have a service or procedure. If you have a Medigap plan – a plan designed to fill in the gaps in Medicare – you can simply use the plan as you normally would without going through with any pre-approval through the company.

Medicare changes things relatively often, and it is possible that this will change in the future. However, for now, you do not need to do anything in advance. It is always wise, though, to have a full understanding of what Medicare covers and how it works prior to taking on a service or procedure that could lead to high out of pocket expenses.

If you have questions about this or anything else pertaining to Medicare, please contact us on our website (http://medicare-supplement.us) or call us at 877.506.3378.


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