Medicare Coverage Facts You Might Not Know

How much do you know about Medicare? If not much, it should not come as a surprise to you. A recent survey shows some interesting insights. 34% of Americans do not know about Medicare at all. 68% will be unable to tell which parts of Medicare to enroll in. 28% don’t know about Medicare Part D, which covers prescription drugs. 19% think that Medicare Part D covers all prescription drug costs.

Indeed if you look at the general knowledge of what Medicare covers, there are a lot of gaps. 31%, for example, believe that Medicare will take care of long-term healthcare costs. 58% of recipients are not even aware that different deductibles exist.

52% don’t know that Medicare covers vaccines, Covid tests, and monoclonal antibody treatment. We could go on with the illuminating statistics, but one thing remains clear. There is still a lot of need for education on Medicare.

Our article seeks to uncover facts you might not know about Medicare coverage.

There are Medicare Care Coverage Options

Medicare is a federal insurance program that has been operational since 1965. It has specific plans, which include:-

  • Medicare Part A also goes by the name hospital insurance. It covers inpatient stays, nursing facilities, or home care.
  • Medicare part B, or medical insurance, covers doctor’s appointments. Others are medical equipment, and therapist visits.
  • Medicare part C or Medicare Advantage includes Medicare Part A and B. It falls under Medicare-approved private insurance companies.
  • Medicare part D takes care of prescription drugs.
  • Medigap or Medicare supplement takes care of out-of-pocket expenses. These include coinsurance, copayments, and deductibles.

As a federal plan, the coverage for Medicare Part A and B (original Medicare) is the same across the 50 states. But there may be differences in Medicare Advantage Plan coverage. If you take Medicare Advantage plans in Florida, the insurance company determines what you pay in premiums. The same applies to Washington, Connecticut, Arkansas, etc.

When you enroll in Medicare Florida, you can access the zero monthly premium. Please note you can decide to stick with the original Medicare, which covers Part A and B.

But you should also sign up for prescription drug coverage. It also doesn’t hurt to get a Medicare Advantage Plan to cover out-of-pocket expenses.

Not Having Part D Medicare Coverage Will Cost You

Let’s start by saying that you do not have to sign up for Part D or prescription drug coverage. But here is where it gets interesting. If you decide to enroll at some point, you will end up paying a late enrollment penalty.

The penalty is 1% of the national base beneficiary premium for every month you did not have the coverage. You will need to pay the fine on the day you sign up for Plan D. That will make the cover quite expensive for you. 

So, the 2022 national base premium is $33.37 per month. Take 1% of that, and it comes to about 33 cents. That means you will pay an extra 33 cents in premiums for Part D going forward.

Your Income Determines How Much You Pay In Premiums

Do you pay more in Medicare premiums depending on your income? The answer is, indeed, you do. The more you earn, the more you pay for Medicare Part B and D. 

Part A does not attract premium payment for most people. Please note that the government takes up 75% of Part B premiums, while you only pay 25%.

But, depending on your IRS income report, you could end up paying up to 85% of the cost. For Part D, you will pay the standard premiums plus an extra amount. The government calculates this based on the base beneficiary premium.

If the amount is greater than what comes from your social security, Medicare federal agencies will bill you separately. Seek the services of Medicare advisors for a better understanding of this.

There are Exclusions to What Medicare Covers

You have enrolled for Medicare in Florida. You get unwell and seek medical services. But, the healthcare provider says your Medicare Florida plan only covers specific things. Well, that is true. The exclusions include dental, hearing, visual, and podiatry expenses. Yet, these are issues that older people tend to suffer from quite a bit.

Your best option is to check out the Medicare Advantage plans in Florida. Please speak to Medicare advisors in your area for guidance. Medicare Advantage of Plan C is, as we said, through private insurance companies. 

You get Plan A and B coverage as per the original Medicare. On top of that, you receive coverage for the exclusions.

Medicare Coverage Does Not Extend To Long Term Care

Please note that Medicare coverage does not extend to long-term care. It will only apply if the long-term stay is in a hospital. Or, you must go through rehabilitative care like therapy to get back on your feet after knee surgery.

So what if you need to hire a full-time home care support team or a home nurse? Well, that will have to come out of your pocket.

Medicare Can Cover Weight Loss Programs

Good news if you are looking to lose some weight. Medicare can cover some of the expenses if you enroll in a program. But, your weight loss must be for the treatment of specific illnesses. So no, your need to look good does not qualify.

Let’s say you suffer from cardiovascular diseases, diabetes, or hypothyroidism. The doctor may recommend losing weight as part of the treatment regime. Medicare can pay for the following:-

  • Health counseling
  • Lifestyle assessment, including eating habits and activity
  • Exercise and dieting education
  • Weight loss monitoring follow-ups
  • Individual counseling, etc.

It helps to familiarize yourself with the policies to know what the Medicare coverage is. It could save you a lot of health-related out-of-pocket expenses.

Final Thoughts

Medicare has a lot of benefits when it comes to healthcare. But, there are also some facts that few people are aware of. From the introduction, you can get a pretty clear picture by looking at the statistics.

It pays to learn everything you can about Medicare. There are tons of resources such as this you can use. 

Finally, we will keep reiterating this point. Seek the services of Medicare advisors near you. They are in the best position to guide you on the best Medicare advantage plans.

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