Medicare can be confusing which is why we compiled seven things you didn’t know about Medicare to help you understand the policy and coverage.
Some Choices Have To Be Made
Conventional Medicare is not the only option on the table.
You can choose to go with traditional Medicare (parts A and B) that allow you to receive medical care from any hospital or doctor in the country that accepts Medicare.
Alternatively, you can go with a Medicare Advantage Plan (part C) that you purchase from a private insurer who offers Medicare benefits.
If you go with traditional Medicare (parts A and B), you’ll also be required to take up an additional plan (part D) for prescription drug coverage.
You can also take up a supplementary coverage plan commonly referred to as Medigap.
It can assist with your additional medical expenses, like deductibles. Some Medigap plans include a max out-of-pocket amount.
This means there is a limit to the amount that you would have to pay every year.
If you choose to go with the Medicare Advantage plans 2021, you’ll most likely get the prescription drug cover, meaning you don’t have to sign up for an additional plan.
The Advantage plan may also offer cover eye and dental care.
However, you’ll have to seek this treatment from a select list of providers that may charge you more.
If you choose the Medicare Advantage plan, you cannot sign up for a Medigap plan.
You May Pay More
With conventional Medicare, there is no out-of-pocket limit.
This means that if you suffer from a severe medical condition, there’s no maximum amount to what you may have to pay from your pocket, which is usually a percentage of the medical bills that you incur.
Medicare for prescription drugs (part D) does have an emergency limit.
This means that after paying a specific amount from your pocket, its emergency cover kicks in.
However, you may still have to pay for up to 5% of the cost of prescription drugs above the limit.
If you require expensive drugs and medications, that cost could increase.
The Medigap supplemental plan can help to ease the burden from these additional costs.
Don’t Wait Till The Last Minute.
The deadline for signing up for Medicare is after seven months.
The clock starts ticking approximately three months before the 65th birthday and progresses for an additional three months after your birthday.
Some individuals will be auto-enrolled in the main Medicare plan, but others will have to sign up.
If you want to know if you have been auto-enrolled, please visit your Social Security Office.
If you are not auto-enrolled and fail to enroll for any of the relevant Medicare plans during the designated enrollment period, you will have to pay a fine in order to enroll later on.
This fine will be charged every month you benefit from Medicare.
The fine or penalty applies for delays in enrolling for Part D Medicare as well.
This means that you should not waste any time deliberating on whether to sign up or not.
Sign up as soon as possible to avoid inconveniences in the event you fall ill.
You will not pay a fine if you obtain coverage via your workplace.
However, since some employers may expect you to sign up for Medicare, you should discuss these details with HR before you get to 65 years of age.
Not Everyone Qualifies For Medigap
If you sign up for traditional Medicare, then Medigap is considered a supplementary plan.
It covers merely some of the costs that the primary plan doesn’t, like deductibles and co-payments.
During the enrollment period, you can purchase any Medigap plan that is available for you.
This is regardless of your health status or any medical condition you may be suffering from.
However, after the enrollment period, you may not qualify for one.
This may bring about a lot of inconveniences and financial problems, especially if you suffer from a serious health complication.
If you go with the Advantage plan instead of the traditional plan but establish that you are not satisfied with it, you can choose to leave the plan within the first year and revert to the traditional plan (the one year grace period is commonly known as the ‘trial-phase’).
If you had a Medigap plan before purchase an Advantage plan or you enrolled for the Advantage plan after you turned 65, you still qualify to enroll for the Medigap policy.
Vision and Dental Coverage is Limited
Medicare doesn’t include dental care unless you require an emergency dental procedure or seek special dental care while staying in a healthcare facility.
It also doesn’t cover eye check-ups for prescription glasses.
However, it does cater to vision check-ups for specific conditions like macular degeneration and glaucoma.
Hearing aids are also not covered by Medicare.
You need an Advantage plan or a supplementary insurance policy for this.
No Extended Care Cover
Among the biggest shocks that many individuals have in regards to Medicare coverage is that it doesn’t include a prolonged or extended care coverage unless the care is considered ‘rehabilitative’ or involves a stay in hospital.
Only certain types of long-term care are covered, such as therapy for knee injuries and surgeries on limbs and joints.
So, if your treatment involves assistance with day-to-day activities like cleaning, bathing, and dressing, Medicare will not cover these.
Medicare doesn’t cover nursing home or in-home care for the elderly.