What Is Medicare?
Medicare is a federal health insurance program offered to U.S. citizens who are 65 and older. Younger people with disabilities, as well as as well as some younger people with disabilities who are on Social Security Disability Insurance (SSDI). People with renal disease who require dialysis are also eligible. Medicare comes in different parts: Part A, B, and D, that cover different healthcare services.
When it comes to signing up to Medicare and choosing the plan that’s right for you, it’s important to know what Medicare covers. While some people think Medicare is free and covers everything they need, the unfortunate reality is that’s not entirely true. In this article, we will explore what things Medicare does (and does not) cover.
According to Medicare.gov, medicare is a federally funded health insurance program for people who are 65 or older, those with disabilities (who qualify), and people with lifelong, chronic major medical needs such as End-Stage Renal Disease (ESRD), which causes permanent kidney failure requiring regular dialysis or a transplant, which typically has a very long waiting list.
Medicare is broken down into Parts: A, B, C, and D. Medicare.gov has updated their prices and estimates, although they do warn that these are not firm guaranteed prices. Rather, they are an estimate for what you may expect to pay. According to Medicare.gov, as of 2020, premiums typically break down as follows:
Medicare Part A
Medicare Part A can be thought of as covering “the big stuff”. This covers more expensive, long-term, and specialized healthcare needs, such as hospital in-patient stays, the costs of nursing homes and hospice, and sometimes in-home care. This is not an exhaustive list, and there are instances when medicare may not cover a service mentioned here, so it’s important to know what your plan covers. You can find out if your Medicare plan covers a service you need here.
Medicare Part B
Medicare Part B is the “everyday stuff”: This covers more routine care, such as doctors’ services, medical supplies, check ups, outpatient services, and preventative care. It may also cover more “catastrophic” things that Medicare Part A doesn’t. Some of these things include routine exams, such as screening for cancer, depression, and diabetes, ambulance and emergency department services, influenza and hepatitis vaccinations, electrocardiograms (ECGs), medical equipment, some drugs, diabetes supplies, and some prescriptions for eyewear. That being said, there are many vision procedures and eyewear needs Medicare may not cover.
What Medicare Parts A & B Don’t Cover
As we mentioned earlier, Medicare doesn’t cover everything. Some of the items and services Medicare doesn’t cover include:
- Long-term care (also called custodial care )
- Most dental care
- Eye exams related to prescribing glasses
- Cosmetic surgery
- Hearing aids and exams for fitting them
- Routine foot care
If you need services Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance or a Medicare health plan that covers them.
Medicare Part C
Medicare part C is a bit different, as it’s a Medicare Advantage plan. Not everybody has Medicare part C, and you will not be automatically enrolled in Part C as you are in Parts A and B when you turn 65 (if you are drawing Social Security Benefits). Medicare Part C is similar to a Medigap plan, but it includes a prescription drug plan and it usually comes at little or no cost (but it’s more limited in terms of doctors and coverage, and can be harder to qualify for).
Medicare Part D
Medicare Part D covers your Medications. This covers prescription drugs, as well as shots and vaccinations. While this plan is optional, it is highly recommended, especially if you have a chronic condition you take medications for. You can sign up with Medicare Part D through a licensed private insurance company. What is and is not covered will depend on the plan you choose, as well as your own circumstances.
I Still Need Help!
If you’re still having trouble finding an appropriate plan, that’s understandable. To get an idea of what your Medicare expenses might be, the Centers for Medicare & Medicaid Services offers an Out-Of-Pocket Cost Calculator. While this isn’t a definitive guarantee of your actual cost, it can help you prepare for what you might be looking at paying.
There are so many details and difficulties to enrolling, navigating the system, and keeping up with what plan will be right for you. Opportunities to save money may go amiss, and certain coverage needs may be overlooked. Don’t go it alone. Get a quote and talk to an insurance specialist today.