The first question many patients ask before signing up for Medicare is, “Can Medicare deny me coverage?” Medicare is a federal program that guarantees coverage for medically necessary services. Medicare was established to guarantee that eligible patients would receive the care they need to cure their diseases. The program was designed to heal the sick and return them to a state of wellness. If treatment is needed to cure or treat an active disease, Medicare coverage will never be denied.
Medicare exists to ensure that eligible patients receive care for chronic and acute illnesses. It’s mandate is not to anticipate possible medical conditions or to alter a patient’s lifestyle. While the program has expanded over the years to include some commonly accepted screening procedures such as pap smears and prostate specific antigen tests, the Medicare program overall does not cover medical services in the absence of active disease. Routine annual physicals are not a Medicare benefit and the program will withhold reimbursement because this service does not fall within it’s legally mandated function. By law, screening procedures are considered a voluntary choice by a patient after consulting with his or her health care provider.
Billions of dollars are spent every year by the Medicare program treating acute illnesses and injuries, as well as chronic medical conditions. When a patient asks, “Can Medicare deny me coverage?” the answer is, “Not if the services provided were needed to alleviate symptoms or cure disease.” Services to prevent possible future events when no symptoms are apparent are not covered. Medicare’s mission is to make the sick well. Services are not necessary in the absence of disease.