Trying to figure out if Medicare will cover you if you need treatment for a sporting injury can be overwhelming. Common injuries that would fall under the term “sporting injuries” include sprains, joint injuries, fractures, muscle strains, and dislocations.
You could need multiple types of services and care if you get diagnosed with one of these things. From an MRI, pain management, lab work, and doctor visits with a specialist, it can start to sound pretty expensive very quickly. You also don’t want to be denied coverage for any of the treatments and services you seek. So, let’s break it all down to help you understand how Medicare covers sporting injuries.
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Medicare Part A and B Coverage
The medical services and treatments you might need due to a sporting injury can vary depending on the type of injury and your health. But whatever the case may be, you will be sure to find coverage for the various care you might need under Medicare.
Say you have a knee injury, and your healthcare provider recommends knee replacement surgery. This news can seem scary, and bringing insurance into the picture does nothing but add stress to the situation. However, we want you to understand that if you have Medicare, it may not be as complicated as you think.
Medicare is divided into Part A and Part B. Part A would provide coverage for your inpatient hospital stay. Depending on your situation, surgery for a sporting injury might get covered under Part A, or Part B. Part B covers your outpatient services, like outpatient surgeries, doctor visits, and lab work.
As for costs, you need to satisfy the Part A deductible before it provides coverage ($1600 in 2023). While Part B covers 80% of your costs after your meet the annual Part B deductible ($226 in 2023). You are then left with the remaining 20% for all your Medicare Part B services.
The point is that medical services such as surgery, diagnostic imaging, physical therapy, lab work, and an inpatient hospital stay are covered by Medicare Part A or Part B. The range of injuries and care you need will vary from person to person, but you can rest a bit easier knowing there is some coverage for you.
For help with your Medicare costs, you can elect to have a Medigap or Medicare Advantage plan. Medigap plans pay secondary to Medicare and have no network restrictions. As long as a provider accepts Medicare and Medicare pays for a service, your Medigap plan will follow suit.
Since Medicare Part B provides coverage for outpatient services like physical therapy, if you were to have a Medigap plan such as Plan G, it would help pick up that remaining 20% Medicare leaves in your hands. Medigap plans also help cover your out-of-pocket costs associated with Part A, such as the Part A deductible. These plans can significantly reduce out-of-pocket expenses and provide you with more predictable healthcare costs.
If you get a sporting injury and opt for a Medicare Advantage plan, you will still receive cost-sharing assistance. It will just work differently.
Advantage plans must cover everything that Medicare Part A and Part B cover. Therefore, you should have coverage for the services and treatments needed for a sports-related injury, such as physical therapy, diagnostic imaging, lab work, or surgery. The copays and coinsurance will vary with each Advantage plan and each treatment or service.
Each Medicare Advantage plan has a maximum out-of-pocket, so at least you know you will never exceed a certain amount for the year. However, you do have a network of providers and pharmacies that must accept your Advantage plan, so it’s critical to keep this in mind if you want to receive treatment such as physical therapy from a particular provider.
Medicare can help
Whether you have sports-related injuries from before you enrolled in Medicare or developed one after, Medicare can provide you with coverage for multiple treatments and services. These injuries can sometimes take quite a while to heal or leave you needing long-term medical treatments and services, which is okay.
A Medigap or Medicare Advantage plan can help you reduce your out-of-pocket costs if, for example, you need multiple sessions of physical therapy or steroid shots to help with pain management. Your healthcare providers can work with you and your Medicare insurance to help you manage your condition and lessen worries about how a sports-related injury will affect you financially.