What does “Medically Necessary” mean to my Medicare coverage?

The term “Medically Necessary strikes fear in the hearts of all that are a part of Medicare coverage across the country.  Somebody, somewhere in some dark room decided that whatever you deem necessary to live a good life is not “Medically Necessary” so you are out of luck.  Or are you?  Consider the following ways to determine if something is “Medically Necessary” and if your situation qualifies:

  1. Are proper and needed for diagnosis, or treatment of your medical condition.  This could be something that your doctor needs or that you need in the course of your medical condition.
  2. Are provided for the diagnosis, direct care, and treatment of your medical condition.  Again the word “treatment” appears in the definition, this word is tricky because many things seem necessary treatment and maybe not “Medically Necessary.
  3. Meet the standards of good medical practice in the medical community of your local area.   This term seems a bit askew because why would someone in another state or county be ok to use the services or procedures, but not you?
  4. Are not mainly for the convenience of you or your doctor.  This is for a very obvious and simple reason as Medicare coverage wants to avoid paying for tools or services that could be a conflict of interest.
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2 Responses to What does “Medically Necessary” mean to my Medicare coverage?

  • Frank Carnello says:

    Is there any program in Medicare that covers Hearing aids. I am almost completely deaf. Thank You

  • DIANE DAVIS says:

    I HAVE A QUESTION ABOUT MY HUSBAND.HIS NAME IS LEWIS L. DAVIS.HE WAS ON SSI FOR 21 YEARS.HE HAS THE GIANTISM DESEASE,SCOLIOSIS, AND ARTHRITIS.HE TURNED 62 LAST YEAR.A FEW WEEKS BACK HE RECEIVED A PHONE CALL AND A LETTER STATING THAT HE WAS PUT ON SOCIAL SECURITY AND TAKEN OFF SSI.HE ONLY RECEIVES 199.00 A MONTH AND HE DRAWS THAT OFF OF ME. HOW CAN HE JUST BE TAKEN OFF OF SSI.HE HAS NO INSURANCE OF ANY KIND, NO PERSCRIPTION COVERAGE NO MEDICAL AT ALL. HE HAS BEEN ON HIS MEDICINE FOR 21 YEARS ALSO . WHAT ARE WE SUPPOSE TO DO.WE CAN NOT AFFORD HIS MEDICAL OR PERSCRIPTION.I AM ON SOCIAL SECURITY DISABILITY BENEFITS AND ONY GET 845.00 A MONTH.MY QUESTION IS CAN HE BE PUT ON MEDICARE BECAUSE IT IS MEDICALLY NESSACARY.HE IS 63 NOW.

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