Medicare is a health insurance program that provides coverage to people over 65, as well as certain younger people with disabilities and end-stage renal disease. Medicare coverage includes many benefits, including hospital care, doctor visits, preventive care, and prescription drugs. It also includes some long-term care services, including nursing homes and home health care.
Medicare divides into four parts, namely, Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage Plans), and Part D (Prescription Drug Coverage). Each part provides different types of coverage and has different eligibility requirements.
In this article, we will provide you with everything you need to know about what Medicare covers. Understanding what Medicare covers can help you make informed decisions about your healthcare needs.
What Types of Services and Treatments Does Medicare Cover?
Most Medicare recipients are over 65, so it’s important for them to stay on top of their health. That means taking steps to prevent illness and catching any health issues early since that’s when treatment is most effective.
It covers hospital stays, skilled nursing facility care, hospice care, and home health care services. This includes inpatient hospital care, nursing facility care, and short-term home health care services.
It covers doctor visits, outpatient care, medical supplies, and preventive services such as screenings for cancer and diabetes, flu shots, and physical exams. It also covers mental health services, lab tests, and durable medical equipment such as wheelchairs and walkers. AARP states that upon enrollment in Medicare Part B, you are eligible for a complimentary “Welcome to Medicare” physical examination within 12 months.
This plan known as Medicare Advantage Plans, may include prescription drug coverage. Some long-term care services, such as home health care and nursing home care, are covered by Medicare under certain circumstances. Additionally, Medicare Part C is a combination of Medicare Parts A, B, and many times D all rolled into one plan.
It covers the cost of prescription drugs and is provided by commercial insurance companies. These companies may offer Medicare Advantage plans that include prescription drug coverage, or they may offer separate Prescription Drug Plans that specifically cover Part D expenses.
It’s important to note that not all medical services and treatments are covered by Medicare. Services such as cosmetic surgery, acupuncture, hearing aids, and routine dental care are not typically covered. However, Medicare Supplement Plans, also known as Medigap, can be purchased to help cover some out-of-pocket costs associated with Medicare coverage.
Medicare’s preventative services consist of
- Depression Screening
- Hepatitis C Screening
- Diabetes Screening and Self-Management Training
- Alcohol Misuse Screening and Counseling
- Annual Wellness Visit
- Bone Mass Measurement
- Cervical Cancer Screening
- Medical Nutrition Therapy
- HIV Screening
- Hepatitis B Screening
- Pap Test Screening
- Ultrasound AAA Screening
- Screening Pelvic Exams
- Prostate Cancer Screening
- IBT for Obesity
- Glaucoma Screening
- Flu Shot & Administration
- Colorectal Cancer Screening
- Lung Cancer Screening
- Initial Preventive Physical Exam
- Mammography Screening
- Hepatitis B Shot & Administration
How do Medicare and Medicare Advantage Plans differ from each other?
Original Medicare is a government-run program that provides coverage for hospitalization (Part A) and medical services (Part B). Beneficiaries can add prescription drug coverage (Part D) and supplement their coverage with Medigap plans.
Medicare Advantage Plans, on the other hand, are offered by private insurance companies and provide all-in-one coverage that includes Parts A, B, and D. They may also provide additional benefits such as dental, vision, and hearing coverage.
See the video below to learn more about their differences.
While both options have their advantages and disadvantages, it’s important for individuals to carefully consider their healthcare needs and preferences before choosing between the two.
How Much Does Medicare Cost and Who Pays for It?
- Medicare Part A (Hospital Insurance) is for those of you who have worked and paid into the Medicare system for at least ten years and do not have to pay a premium. However, if you or your spouse did not pay enough Medicare taxes while working, you may have to pay a premium for Part A coverage.
- Medicare Part B (Medical Insurance) covers doctor visits, outpatient care, and preventive services. There is a standard monthly premium for Part B,
and Part B costs $164.90 per month in 2023.
- Medicare Part C (Medicare Advantage Plans) combines Parts A and B and, in many plans, Part D coverage as well. Many Medicare Advantage plans have a $0 per month cost, depending on the carrier and county in which you live.
- Medicare Part D (Prescription Drug Coverage) provides coverage for prescription drugs. There is a monthly premium for Part D, and the cost varies depending on the specific plan an individual chooses.
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What Are the Different Types of Medicare Insurance Plans Available?
There are several types of Medicare insurance plans available to beneficiaries.
- Original Medicare (Parts A and B): This is a government-run program that provides coverage for hospitalization (Part A) and medical services (Part B).
- Medicare Advantage (Part C): These plans are offered by private insurance companies and provide all-in-one coverage that includes Parts A, B, and D. They may also offer additional benefits such as dental, vision, and hearing coverage.
- Prescription Drug Coverage (Part D): This type of plan is offered by private insurance companies and covers the cost of prescription drugs.
- Medicare Supplement (Medigap): These plans are also offered by private insurance companies and provide additional coverage to help pay for out-of-pocket costs associated with Original Medicare.
Who is Eligible for Medicare?
Eligibility for Medicare requires meeting one of the following criteria:
- You are 65 or older to enroll.
- You’re under 65 years of age with a disability.
- You have an end-stage renal disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
It’s important to note that there are specific enrollment periods for Medicare, and failing to enroll during these periods can result in penalties or gaps in coverage.
When Can You Enroll in Medicare?
There are specific enrollment periods for Medicare, and knowing when to enroll is important to avoid penalties or gaps in coverage. Here are the different enrollment periods for Medicare.
1. Initial Enrollment Period (IEP)
This is the first time you can enroll in Medicare, a seven-month period that begins three months before your 65th birthday and ends three months after your birthday month.
2. General Enrollment Period (GEP)
This enrollment period is for individuals who have Medicare Advantage plans. The MA-OEP is between January 1 to March 31 annually, and the coverage becomes effective the following month after the enrollment occurs.
3. Special Enrollment Period (SEP)
This can occur throughout the year, and there are 19 different circumstances that can qualify you to change plans using SEP as the reason to do so. This can be as simple as a qualifying life event like moving or being affected by a natural disaster like a hurricane.
Check out the video below.
4. Annual Enrollment Period (AEP)
This enrollment period allows individuals to make changes to their Medicare coverage each year. The AEP period is from October 15 to December 7.
Conclusion: Understanding Your Options and Knowing What Medicare Covers
As someone who works in the healthcare industry, I know firsthand how confusing Medicare can be. But understanding what Medicare covers is a crucial part of making informed decisions about your healthcare. Remember, Medicare is a great resource for many healthcare services, but it’s not a one-stop shop for everything.
To ensure you’re getting the coverage you need, I recommend using the Medicare Plan Finder tool if you reside in CA. Otherwise, check out the Medicare.gov website for your specific zip code. This online tool allows you to compare different Medicare plans in your area and find one that fits your specific needs. It’s a quick and easy way to ensure you get the most out of your Medicare benefits. If you do not live in CA, check out the Medicare.gov website for your zip code, and use their tool. But beware, I would not call the number on the screen or click to enroll. Just use it for research.
If you’re feeling overwhelmed or have more questions about Medicare, don’t hesitate to schedule a phone call with a local broker. Southern CA residents can schedule with me.
Make sure to follow me on social to see my video content about this confusing industry.
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