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What You Should Know About Medicare

Medicare provides healthcare insurance for over 56 million Americans, but some people still don’t know everything they should about this program. In this blog, our goal is to give you a quick rundown on what medicare is and how it could be helping you. 

 

 

A Brief History

Discussion of a national healthcare program can be traced back all the way to Teddy Roosevelt who discussed it during his campaign for president in 1912. This idea didn’t really start gaining traction until Harry Truman was president. On November 19, 1945, President Truman sent a message to congress about a national insurance fund that would provide health insurance for all Americans. Truman wanted this to help Americans cover basic health needs such as doctor’s visits, dental care, and hospital visits. Truman was unsuccessful in getting a bill passed while he was president and it would be another 20 years before a form of national health insurance bill was passed, Medicaid was signed into law by President Lyndon B. Johnson on July 30th, 1965. Medicaid was for Americans 65 and older, this was unlike passed proposals that pushed for coverage for Americans of all ages. Nowadays Medicare still covers seniors who are 65 and older, but it also covers younger people who have disabilities and people with End-Stage Renal Disease.

The Different Parts of Medicare

Medicare consists of four parts: Part A, Part B, Part C, and Part D. Part A covers hospital insurance, including hospice care, skilled nurse care, and some in-home hospice care. Part B covers medical insurance, including doctor visits, medical supplies, vaccines, and outpatient care. Part C is the Medicare Advantage program, this bundles Part A, Part B, and (sometimes)Part D into one plan. Lastly, Part D covers prescription drugs. 

Know When To Enroll

 Most people think that when you turn 65 you are automatically enrolled in Medicare, but that is not the case! Unless you are already enrolled in Social Security before you turn 65, you will not automatically be enrolled in Medicare. When you turn 65 you have a 7 month initial enrollment period for Medicare Part A and/or Part B that starts three months before you turn 65, includes the month you turn 65 and ends three months after you turn 65. If you do not sign up during your enrollment period, you will have to pay a late enrollment penalty to continue to pay as long as you have Part B Medicare. You may be exempt from this fee if you qualify for Special Enrollment Periods, to read more on this visit here.

 

Know What is Covered

Medicare Part A will cover 100% of your hospitalization costs once your deductible is met, but not forever. Once you reach the 60-day mark, you must start paying a percentage of the expenses, and then after 90 days, if you have used up your 60 days of lifetime reserve days, you are responsible for 100% of the expenses. That being said, make sure you have done your research and are prepared for what you may have to pay.

 

 

Not All Medicare Advantage Premiums Are The Same

Medicare Advantage plans are not all sold by Medicare. Medicare actually makes payments to insurance companies that sell Medicare Advantage Plans. Some of the plans from these insurance companies may have $0 premiums, while others may offer more than the most basic coverage, but they may charge higher monthly premiums. Since there are so many factors that affect the cost of your premiums make sure you look at all your options before making your decision. 

 

Preventative Health Services

Yes, you most likely will have to pay Medicare Part B premiums and deductibles, but there are actually things that are free to you. As a member of Medicare, many preventative health services are free of charge. This includes things such as cancer screenings, tests for cardiovascular disease, and much more. You can also get free annual health visits that include things such as vaccines and shots! There are more free services than we could include in this blog so to see a full list of free preventive health services just click here.

Medicine Coverage

I will say it again for the people in the back, not all Medicare plans are created equal. This is still the case when it comes to medication coverage. Plan D drug plans and Medicare Advantage Plans must follow certain guidelines when it comes to drug coverage but after that, there is still a lot of room for them to make their own adjustments on what medicines are covered and how much you will have to pay. When picking a coverage plan or switching plans, please don’t assume that you will be paying the same for your medications, because you probably won’t. Discuss the coverage of certain medications before making your decision.

 

Look Into Medigap Coverage

Medicare Part A deductible is currently $1,484 per year, and the Medicare Plan B deductible for all beneficiaries this year is $203. After using up your 60 lifetime reserve days with Medicare Part A you will be responsible for the coinsurance amount of $371 per day for the 61st through 90th day of hospitalization and $742 per day for lifetime reserve days after the 90th day. You will also always be in charge of paying 20% coinsurance for Part B services, no matter how much you have spent. To prevent a terrible injury or illness from taking a chunk out of your bank account you may want to consider looking into a Medigap coverage plan. These plans charge monthly premiums but they help cover the difference when medicare can’t cover the cost. To get a Medigap plan you will need to be enrolled in an original Medicare plan and you will not qualify if you have a Medicare advantage plan. 

 

Don't Stress

I know that all this information can be a little overwhelming and confusing but don’t sweat it. If you do your research and make sure you understand your coverage plan you will be okay! There is also always a way to get a helping hand in this daunting process, you can call MEDICARE at (800)633-4227, that’s 1-800-MEDICARE. You can also get personal counseling through SHIP(State Health Insurance Assistance Program). 

SHIP can answer any questions you have regarding Medicare including coverage, deductibles, benefits, services, enrollment and more. 

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Dwell at Home is not a licensed medical professional and all information provided is provided “as is” with no warranties. You should consult a licensed physician for any questions related to your health.  Dwell at Home makes no guarantee about any application or third-party website mentioned in any article on this website.