As of 2017, the number of Medicare enrollees recorded was at 49.5 million beneficiaries due to age. 8.9 million are due to disabilities.
Yes, Medicare is that important to so many people.
At first glance, Medicare seems overwhelming and may be a lot to take in. Thus, it’s important to take time and understand how your medical plan works.
Don’t worry, we’ve got you covered. Here are ten Medicare facts that you should know to prepare for.
1. Medicare Comes in Parts
Medicare comes in different parts: A, B, C, and D. Each of these have a different set of expenses to cover.
Medicare Part A handles hospital insurance. It covers inpatient hospital care and certain home care. It’s also a prerequisite to be able to get the other Medicare Plans.
Medicare Part B provides health insurance coverage for medically necessary services, as well as preventative services. This is the optional part for the original Medicare.
Medicare Part C runs under a different name called Medicare Advantage. It offers the same benefits as Original Medicare. Although private insurance companies offer this, it may also include additional benefits.
Medicare Part D is the optional prescription drug coverage. It’s also provided by private insurance companies. To note, both Part C and D are under federal government regulation.
2. Medicare Comes with a Cost
One of the Medicare Facts that you should take note is that Medicare is not free.
A good thing to note for this is that Medicare Part A is free. Given that you or your spouse paid the Medicare payroll taxes for at least ten years. If in case you are not qualified for the free Medicare Part A, you can pay a monthly premium of $700.
Medicare Part B needs a monthly premium of $134 as of 2018. Among the services that Part B covers include doctor visits and outpatient services.
As for Medicare Part D, which covers prescription drug costs, this one has variations depending on the plan that you chose. At average, Part D premium costs about $35 a month.
In addition to premium costs, co-payments, deductibles, and other out-of-pocket costs come into play.
3. Medicare Starts at Age 65
Eligibility to Medicare starts at age 65. If you are receiving Social Security benefits at that age, your enrollment in Parts A and B is automatic.
Due to the nature of Part B requiring monthly premiums, you have the option to turn that down. But if you keep it, the cost gets deducted from your Social Security if you have claimed benefits.
If you haven’t started Social Security, you will have to sign up for both Parts A and B.
During this time, you need to enroll within the seven-month enrollment period. This starts three months before the month you turn 65, which is the best time to sign up.
4. Medicare Covers a Lot but It Has Gaps
Medicare offers wide coverage but it also has gaps in what it covers and how much it can cover.
Among the medical services that it does not cover, this includes long-term care. For distinction purposes, it means it would not be able to cover custodial care in the general sense. This is where your long-term care insurance would come in.
Also, Medicare is unable to cover these services:
- Dental care
- Hearing aids
- Routine chiropractic care
- Eye exams and eyeglasses
- Routine foot care
- Medical care while abroad
For this, you will need the best Medigap plans to cover for them.
5. Medicare Covers 80% of Eligible Medical Expenses
Let’s also look at qualified expenses that Medicare can cover.
Medicare is capable of covering about 80% of your medical bills. The 20% coinsurance will still fall on you, which could come costly in a medical emergency.
You will need to find ways to cover the 20%. Consider looking into Medicare supplements to find ways to answer that gap.
6. Income Determines Medicare Premiums
One thing to note about Medicare Part B is this. Incomes determine the amount of premium required on a monthly basis. The higher the income, the higher the premium is for Parts B and D.
7. You Can Appeal for the Premiums
As mentioned in the previous point, high income can cause an increase in the monthly premiums needed.
In the event that your income went down since the previous tax return due to drastic life-changing events in your life, you can appeal to counter the high-income surcharge. You can check this out to know more about it.
If your income suddenly increased for other reasons, you will need to pay the higher-income premium.
8. You Need to Sign up on Time
The seven-month enrollment period is the best time to enroll for Medicare. However, enrolling late may net you with a penalty fee that goes on top of your monthly premium.
While this applies for Part B, it increases by 10% for every full 12-month period delay and will last for the entire time you have the coverage.
9. You Get More Free Preventive Services
One of the Medicare benefits that you can make use of is in preventive services. Beneficiaries can receive many free preventive services that they can avail for.
Among these include an annual wellness visit for free. This aims to develop or update a personalized prevention plan. Every five years, a free cardiovascular screening is also available.
Extra services that also come for free include annual mammograms and flu shots. You also get free screenings for cervical, prostate, and colorectal cancers.
10. Medicare Covers Some Weight Loss Programs
Under certain conditions, Medicare may also pay for weight loss programs. For instance, if it’s an integral procedure and part a bigger treatment (e.g. diabetes, or cardiovascular diseases). Medicare will help in paying for the program.
Also, if the doctor requires weight loss before surgery, Medicare can also cover for the weight loss program.
There are also other services that Medicare would cover within this vein. Such services are as follows:
- Initial assessment of eating habits and activities
- Health counseling
- Dieting and exercise education
- Follow-up visits for monitoring progress in weight loss program
As long as it fits the conditions laid out, Medicare may take it as part of its coverage.
Remember These Medicare Facts and Learn More Today
When it comes to your Medicare, you need to know and prepare. This way, you can get the most out of it. With these Medicare facts, you should be able to plan accordingly and enjoy your retirement without worry.
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