In January 2019, the Centers for Medicare and Medicaid Services announced the launch of their very first app, called What’s Covered. The purpose of this app is to give Medicare beneficiaries an easy way to understand their coverage.
The idea is that beneficiaries can use the app at the doctor’s office or hospital to check whether a recommended service or test is covered. It’s a great idea, but there are both pros and cons to the Medicare app.
The pros of the Medicare app
For the most part, the Medicare app has more pros than cons. However, the few cons the app does have can be frustrating for Medicare beneficiaries. Since its launch in January 2019, there have been several updates to the app. The software engineers working with CMS take app reviews to heart and continue to try to perfect it for users. The Medicare app overall is a net benefit for users.
The items and services directory
The What’s Covered app has a complete alphabetical list of medical items and services. Beneficiaries can scroll through this list and click items or services they’d like more information on. The app will let them know if Medicare covers it or not, what type of coinsurance they might pay, and any helpful additional notes.
On the downside, if you can’t find a specific item or service on this list, you may need to look elsewhere for information.
The preventive services list
Medicare Part B covers many preventive services at 100%, so most enrollees want to take advantage of free care. However, many preventive services are only covered under certain conditions. If beneficiaries get preventive services outside the covered schedule, they may have to pay the full cost. The preventive services list shows Medicare beneficiaries the specific guidelines for each preventive service.
The Medicare app can switch between English and Spanish. Like the Medicare website, the Medicare app is accessible to Spanish-speaking enrollees. To change the language setting, go to the menu and press the language drop-down to choose between English and Spanish.
The cons of the Medicare app
While the What’s Covered app was well conceived, there are still some issues that haven’t been resolved.
Specific searches for items or services
Users can scroll through the directory of items and services to find what they’re looking for, but they can also use the search bar. However, if users search for something too specific, they may not get any results.
For example, if someone wanted to know how Medicare covers a heart transplant, “heart transplant” isn’t a recognized term. Only a less specific search for “organ transplant” will turn up results.
This was a much bigger problem before recent app updates, however. Before, users couldn’t even type “transplant” and get a result. Now, if someone types transplant, the results for organ transplant should surface.
Unfortunately, this is a complicated fix. The engineers would have to code an almost infinite number of transplant words to get users the correct results.
General “yes or no” information
Medicare has specific coverage rules for each item or service. Generally speaking, many items are covered, but only if the beneficiary meets all the required conditions. The app just isn’t capable of sorting out everyone’s unique situation, so it may say an item is covered when it’s not, or say it’s not covered, when it could be under the right conditions.
In other words, a yes answer means Medicare generally covers the service if the claim is coded correctly and all required documentation is complete. And a no answer doesn’t necessarily mean that Medicare won’t cover the item or service.
Depending on the situation, Medicare may cover something that the app says it doesn’t. App users should trust this information up to a point, but also be aware that everyone’s situation is unique. Don’t forget, you can always appeal a decision you don’t agree with—but the app doesn’t spell that out.
Finally, Medicare cost information may differ depending on the user’s plan coverage. This issue can’t be avoided since Medicare can only display what is generally covered and not covered, and what the expected cost sharing might be.
Again, overall, the Medicare app is more useful than not. It’s not a bad idea to download it and use it to check benefits whenever you access medical care.
Danielle K. Roberts is a Medicare insurance expert and co-founder at Boomer Benefits, where her team of experts help baby boomers with their Medicare decisions nationwide.