Medicare Basics Everyone Must Know Before Turning 65
Millions of older adults rely on Medicare for their health care needs.
However, individuals are not aware that Medicare does not cover a number of common health insurance services. This can be frustrating for those who are not familiar with the program.
Here we will outline some of the most common health insurance services that Medicare does not cover. Keep in mind that this list is not exhaustive, and there may be other health care services that are not covered as well.
If you have any questions about what is and is not covered by Medicare, be sure to speak with your healthcare provider. And finally, remember that there are other options available to you if you need coverage for services that are currently not included in Medicare.
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Common Health Benefits Not Covered By Medicare
Medicare is a government-run health insurance program that provides access to coverage for seniors and people with disabilities. Despite being a government-run program, Medicare doesn’t cover many common services, such as dental care, eye exams, or hearing aides.
The government is looking into adding some of these needed coverages, however, as of 2022, these discussed changes to Medicare have not been made.
Also, Medicare doesn’t cover long-term care, such as nursing home care or in-home care as part of your health care services. For people who need access to these services, a separate policy might be able to cover these exposures to help cover the costs.
Medicare supplement insurance is a private insurance policy that can be purchased to supplement Medicare. Medicare supplemental policies vary in terms of what they cover, but some common services that are covered include dental care, vision services, and long-term care.
For older adults who need access to these services, Medicare supplemental insurance can help to fill the gaps in coverage.
Original Medicare Does Covers The Following Medical Services
While Original Medicare doesn’t cover everything, most of the major health care services are covered by Medicare.
These include some of the following:
Doctor’s services including inpatient and outpatient care
Skilled nursing facilities
Home health services
Diagnostic hearing coverage
Mental Health Services
There are other options available to you if you need coverage for services that are not included in Medicare. For instance, we offer one of the best dental, vision, and hearing coverages available.
If you find yourself in need of a health insurance service that is not covered by Medicare, there are still other options available to you. Many private insurance companies offer Medicare supplemental policies that can help to cover the costs of services not covered by Medicare.
These Medicare policies vary in terms of what they cover, so be sure to shop around and find one that meets your needs.
There are also a number of government programs that can help to cover the costs of certain services not covered by Medicare. For example, Medicaid can help to cover the costs of long-term care for those who qualify.
Speak with one of our independent Medicare insurance agents to learn more about how to access the options available to you.
Preventive Services Covered by Medicare
Medicare Part B. covers preventive services as part of your medical insurance. These preventive services are designed to prevent illness or disease or to detect it at an early stage when treatment is most likely to be successful.
Preventive services can be provided by a doctor or other health care provider who accepts medical insurance through Medicare. Preventative services are also offered through certain screenings, vaccinations, and counseling services.
Some of the preventive services covered by Medicare Part B include:
- Annual wellness visits
- Cancer screenings
- Flu shots
- Glaucoma tests
- Hepatitis B shots
- HIV screenings
- Nutrition counseling
- Obesity screening and counseling
- Prostate cancer screenings
- Smoking cessation counseling
Visit the official Medicare website to learn more about the preventive services covered by your medical insurance. You can also speak to your doctor or health care provider to see if you are eligible for these services.
Preventive care is integral to maintaining your health, so take advantage of all that Medicare has to offer!
Medicare Advantage Plans Offer An Alternative To Original Medicare
Medicare Advantage plans, also known as Medicare Part C, are an alternative way to receive your health care benefits. These plans are offered by private Medicare insurance companies and must provide at least the same level of coverage as Original Medicare (Medicare Part A and Medicare Part B).
Advantage plans may also offer additional benefits, such as prescription drug coverage, vision, and dental.
If you sign up for a Medicare Advantage plan you are not able to obtain a standalone prescription drug plan.
While Medicare advantage plans can offer more comprehensive coverage, they may also come with more restrictions. For example, some Advantage plans require you to see doctors within their network or may not cover out-of-state care.
This can be frustrating for older adults who are not familiar with what is and is not covered by the health insurance program. If you are considering enrolling in an Advantage plan, it is important to do your research to make sure the health insurance plan you choose will meet your needs.
If you visit a doctor outside of your medical network, you may have to pay the full cost of your care.
As mentioned this is one of the biggest drawbacks of Medicare advantage plans is that they often have very restrictive networks.
This means that if you need to see a doctor who is not in your plan’s network, you may have to pay the full cost of your health care. This can be a significant financial burden for older adults who need to see specialists or receive care outside of their home state.
Another downside of Advantage plans is that they often come with high out-of-pocket costs. This can include deductibles, copayments, and coinsurance.
For older adults who have significant medical needs, these costs can add up quickly. Be sure to compare the costs of different Advantage plans before enrolling in one to make sure that it is the right fit for you.
What Are Some Of The Most Common Health Insurance Services Medicare Doesn't Cover
Medicare is a health insurance program for people 65 and older, as well as for those under 65 with certain disabilities. Medicare does not cover all health care services, however. Below are some of the most common health coverage services that are not covered by Medicare:
Routine dental care and oral surgery
Routine eye exams and vision correction surgery
Routine foot care
Private room at the hospital
Long-term care (such as nursing homes)
Acupuncture, chiropractic services, and other alternative medicine
Hearing aids and routine hearing exams
Routine vision checks may be covered
Home health care (unless it is medically necessary)
Following are gaps left behind by Original Medicare:
Medicare only covers a limited amount of home health care services.
Medicare pays for 80 percent of the cost of outpatient mental health services under Part B.
Medicare Part A covers inpatient mental health care received while in the hospital.
Medicare Part B does not cover outpatient mental health care received in a doctor’s office
Medicare Advantage plans (Medicare Part C) may offer more coverage than Original Medicare for some of these services. For example, some Advantage plans include basic routine dental and vision care. However, these plans typically have higher premiums than Original Medicare.
It’s important to check with one of our Medicare insurance agents to find out what services are covered under the different health care plans in your area.
Medicare will provide you with a book each year that outlines important information related to changes, new health insurance companies, and more.
A Medigap plan is a popular option that can fill in all of the gaps left behind by Original Medicare depending on which plan you purchase. Many people prefer this option as they have the freedom to go to any doctor and medical facility that accepts Medicare.
What Is A Medicare Supplement Plan And Are They A Good Alternative To A Medicare Advantage Plan
Medicare supplement plans, also known as Medigap plans, are designed to help cover some of the out-of-pocket costs not covered by Original Medicare.
Medicare supplement plans are offered by private insurance companies and are standardized by the Centers for Medicare & Medicaid Services (CMS).
Advantage plans, on the other hand, are offered by Medicare-approved private insurance companies and provide all Medicare Part A and Medicare Part B benefits. While both Medicare supplement and Medicare Advantage plans can help cover some of Medicare’s out-of-pocket costs, they work differently.
Medicare supplement plans only cover Medicare Part A and Medicare Part B deductibles copays, and coinsurance costs, while Advantage plans may also cover Medicare Part D prescription drug costs.
In addition, Medicare Advantage plans typically have lower premiums than Medicare supplement plans. However, Medicare supplement plans do not have networks like Advantage plans, so enrollees can see any doctor that accepts Medicare.
Overall, both Medicare supplement and Advantage plans can be good options for seniors looking for help with their out-of-pocket costs. It’s important to compare the two types of plans before making a decision to see which one best suits your needs.
Medigap Plan G is one of the most popular Medicare supplement plan.
Plan G covers all of the same things as Plan F except for the Part B deductible.
This is what makes Plan G so popular for most older adults: it has low monthly premiums and still provides high health care coverage levels.
In 2022, the Medicare Part B deductible is $233. So if Medicare beneficiaries choose Plan G, they would only be responsible for paying the first $233 of any Medicare Part B medical expenses.
After that, your Medigap Plan G would cover 100% of eligible costs for the remainder of the fiscal year.
If you are an older adult and want the peace of mind of knowing that all of your Medicare out-of-pocket costs are covered, then Plan F might be the best option for you. However, Plan F is no longer available to new Medicare enrollees after January 1, 2020.
If you’re already enrolled in Plan F, you can keep this health insurance plan as long as you want.
Standalone Medicare Part D Prescription Drug Coverage Versus Medicare Part D Plan Included In A Medicare Advantage Plan
Medicare Part D provides access to insurance coverage for prescription drugs to everyone with Medicare. You can get a Medicare Part D plan through a Medicare Advantage plan (Medicare Part C) or a standalone Medicare Part D plan to cover your prescription drugs.
Advantage plans are offered by private companies that contract with Medicare to provide all your Medicare Part A and Medicare Part B benefits. Some Advantage plans also include Medicare Part D. If you are enrolled in an Advantage plan you can not enroll in a standalone Medicare Part D plan.
If you are enrolled in Original Medicare with a Medicare supplement plan, you can enroll in a standalone Medicare Part D plans that offer only Medicare Part D.
You can enroll in a Medicare Part D plan if you have Medicare Part A, Medicare Part B, or both.
If you have a Medicare Advantage Plan, you can switch back to Original Medicare and then enroll in a stand-alone Medicare prescription drug plan during the yearly Open Enrollment Period from October 15 to December 7.
If you have Original Medicare, you can join a stand-alone Medicare Part D plan during the yearly Open Enrollment Period from October 15 to December 7.
Some people with limited incomes and resources may be able to get help from their state Medicaid program to pay for their premiums and some of their out-of-pocket costs in a stand-alone Medicare Part D covering their prescription drugs. You can get more information about this by contacting your state Medicaid office or your local social security office.
There are a few important things to consider when choosing between a Medicare supplement plan and an Advantage plan.
First, you need to decide if you want or need a plan to cover prescription drugs. If you have a creditable prescription drug plan through an employer or VA hospital you do not need Medicare Part D.
Second, compare the premiums for each plan type – Medicare supplement plans typically have higher premiums than Medicare Advantage plans. However, Medicare Advantage plans often have out-of-pocket costs, such as deductibles and copayments, that can add up to more than the premium for a Medicare supplement plan.
Finally, think about whether you want the flexibility to see any doctor who accepts Medicare or if you’re willing to use a network of doctors. If you want the freedom to see any doctor, then a Medicare supplement plan is probably your best option.
But if you’re willing to use a network of doctors, then a Medicare Advantage plan might be a better choice for you.
Enrolling In A Medigap Policy
If you decide that a Medicare supplement plan is right for you, there are a few things you need to know about enrolling in one.
Medicare beneficiaries will need to review all of the important information related to the Medicare plans provided by the health insurance companies.
You must be enrolled in both Medicare Part A and Medicare Part B to be eligible for Medicare supplement insurance.
To qualify for guaranteed issues rights, you can only enroll in a Medigap plan during your six-month Medigap Open Enrollment Period. This period starts the first day of the month that you’re both 65 or older and enrolled in Medicare Part B.
If you enroll in a Medigap policy outside of your Medigap Open Enrollment Period, or outside a special enrollment period, you may have to pay more for your premiums or even be denied coverage.
There are 10 different types of Medigap plans available, each with its own benefits and costs. You’ll need to compare the health insurance plans to find the one that best meets your health care needs and budget.
Each of these health insurance plans offers different levels of medical care related to your out of pocket expenses.
The higher the monthly premium the more health care expenses will be included your medical insurance.
Finally, to enroll in a Medigap plan you need to enroll with a licensed Medicare insurance agent.
When you’re ready to enroll in a Medigap plan, the first step is to contact our Medicare insurance agency and talk with one of our licensed insurance agents that sells Medigap plans in your state.
The licensed Medicare insurance agent will need some personal important information, including your Medicare number and the date your Medicare Part B started.
You’ll also need to decide how you want to pay your monthly premiums. Most health insurance companies offer several options, such as monthly direct debit from your bank account or credit card, or quarterly or annual billing.
Enrolling In A Medicare Advantage Plan
If you decide that a Medicare Advantage plan is right for you, there are a few things you need to know about enrolling in one.
First, you must be enrolled in both Medicare Part A and Medicare Part B to be eligible for a Medicare Advantage plan.
Second, you can only enroll in a Medicare Advantage plan during your Initial Enrollment Period or during specific times throughout the year, such as during the Annual Election Period or a Special Election Period.
Third, you’ll need to choose a plan that’s offered in your service area. To access plans that are available where you live, Integrity Now Insurance Brokers can help you find an Advantage plan in your local area. Once you’ve found a plan you’re interested in, we will help you enroll.
When you’re ready to enroll in a Medicare Advantage plan, you’ll need to provide some personal information, including your Medicare number and the date your Medicare Part B started.
Most Medicare Advantage plans are HMO plans. You will be required to obtain prior authorization to cover treatment for most medical care.
You’ll also need to decide how you want to pay your premiums. Most health insurance companies offer several options, such as monthly direct debit from your bank account or credit card, or quarterly or annual billing.
Enrolling In A Medicare Prescription Drug Plan
If you decide that you need Medicare Part D, there are a few things you need to know about enrolling in a Medicare Part D health insurance plan.
First, you must be enrolled in Medicare Part A or Medicare Part B to be eligible for a Medicare Part D Plan.
Second, you can only enroll in a Prescription Drug Plan during your Initial Enrollment Period or during specific times throughout the year, such as during the Annual Election Period or a Special Election Period.
Third, you’ll need to choose a plan that’s offered in your service area. One of our licensed Medicare insurance agents will help you find the best plans that are available where you live,
When you’re ready to enroll in a Medicare Part D plan, you’ll need to provide some personal information, including your Medicare number and the date your Medicare Part B started.
You’ll also need to decide how you want to pay your premiums. Most insurance companies offer several options, such as monthly direct debit from your bank account or credit card, or quarterly or annual billing.
Medicare Part D Late Enrollment Fee
If you decide not to enroll in a Medicare Part D plan when you’re first eligible, you may have to pay a late enrollment penalty. The Medicare late enrollment penalty is an amount that’s added to your Medicare premium for each month that you didn’t have Medicare Part D.
For example, let’s say you didn’t enroll in a Prescription Drug Plan until two years after your Initial Enrollment Period. You also did not have creditable coverage in place during this time.
This means you went 24 months without a prescription drug plan. If your monthly premium is $30, the Medicare late enrollment penalty would be $7.20 (that’s 24 months x $0.30). In this example, you would pay a total of $37.20 per month for your Prescription Drug Plan premium.
You may be able to avoid the late enrollment penalty, if you can show that you had other prescription drug plan, such as through a job-based plan, a union health insurance plan, VA healthcare, or an Indian Health Service plan.
You may also be able to avoid the Medicare late enrollment penalty if you qualify for a Medicare special election period. A Special Election Period is a time when you can enroll in or change your Part D plan outside of the Medicare Annual Election Period. You may qualify for a Medicare special election period if you move, lose other prescription drug plan, or qualify for Medicaid.
If you’re not sure whether you’re required to pay the Medicare late enrollment penalty, contact one of our certified Medicare insurance agents.
Medicare Coverage Outside the United States
Medicare is a vital health insurance program that provides coverage for millions of Americans. However, it is important to note that Medicare coverage does not extend outside of the United States.
This means that if you are traveling internationally, you will not be able to rely on Medicare to cover your emergency care abroad.
While some travel insurance policies provide limited coverage for emergency care abroad, it is always best to purchase a policy that specifically covers your health care needs while you are away from home.
By doing so, you can ensure that you will be able to receive the care you need in the event of an emergency.
When does Medicare cover health care services in a foreign hospital?
Certain types of medical treatment you obtain in a foreign hospital may be eligible for Medicare coverage under three conditions:
You’re in the United States when you have a medical emergency, and the foreign hospital is closer than any other U.S. facility that can help.
You’re traveling from Alaska heading towards Washington State and you are required to travel through Canada without unreasonable delay when a medical emergency occurs, and the Canadian hospital is closer than the nearest U.S. hospital that can treat your emergency medical condition. Medicare determines what qualifies as “without unreasonable delay” on a case-by-case basis.
If you live in the United States but the foreign hospital is closer to your home than the closest U.S. facility that can treat your medical problem.
Remember, Medicare will only pay for the Medicare-covered services you receive in a foreign hospital in these instances.
We Are Your Medicare Insurance Expert Agency
If you are an older adult looking for more information about Medicare Advantage Plans, Medicare Part D, or Medicare Supplement plans, please reach out to Integrity Now Insurance Brokers.
We are licensed independent insurance agents who can help you find the plan that is right for you.
With over 20 years of experience helping people navigate the complex world of Medicare, we are here to answer your questions and help you make the best decision for your needs.
Integrity Now Insurance Brokers is a full-service insurance agency that provides Medicare insurance plans to residents all across the United States.
We have a team of experienced and qualified Medicare agents who are more than happy to help you find the perfect plan for your needs.
Contact us today for more information or to get started on your free quote!