6 Surprising Facts About Medicare

The health insurance contest is one of the trickiest out there. It’s not easy to get your head around all these offers, providers and constant changes. But it doesn’t mean you shouldn’t try – after all, it’s about your health and your money. Health expenses are the most common reason among people who are filing for bankruptcy in the US, that’s why it’s so important to choose well. Medicare has been around since 1965, but it doesn’t mean people had time to get to know it – it’s changing, just like everything else. It’s an enormous program which requires you to make choices so it really can get a little confusing. So be prepared – there are some facts about Medicare that may surprise you:

There’s a wide range of options

Did you think that you can just buy a general Medicare health insurance and then you’re safe? Unfortunately, it’s not that easy, especially if you seek a low-budget option. There are three main parts of Medicare: Medicare Parts A, B and C but the choices don’t stop there. 

Parts A and B cover access to hospital care and any doctor or hospital that accepts Medicare. If you choose it, you will probably go for a Part D as well because it’s the only way you can get coverage for prescription drugs. There’s also something called Medigap that can help you with any out-of-pocket costs, like deductibles. Most of them, though, has some maximum amount of money that you can pay yearly.

Part C is an advantage plan that you can buy from a private insurance provider who deals with Medicare benefits. It mostly covers prescription drugs, so there’s no need for any Part D in that case. Very often, it covers dental expenses or even eyeglasses. The limitation is that this plan has its own network of providers so you can’t go to just any Medicare doctor; sometimes it may be more expensive, and you can’t buy any supplemental policy like Medigap.

Technically, it’s mandatory

If you collect Social Security benefits and you turn 65, you have to enroll in Medicare Part A. If you don’t want to, you will need to repay all your Social Security benefits, as a Part A is free for people who worked at least 10 years (and earned a minimum of 40 credits required or are married to someone who did). If you don’t collect your Social Security benefits, you can delay enrolling in Medicare without any penalty under certain conditions. 

It may turn out to be more expensive than you thought

Unluckily, with a regular Medicare plan, there are no limits when it comes to out-of-pocket expenses. So if you have serious health issues and require a lot of medical help, you don’t really know how much you will have to spend for your co-insurance (the part of your medical expenses that you have to cover). A Medicare Part D has a catastrophic coverage, so it helps you if your expenses get too high, but you still need to pay 5% of the cost of any prescription drugs – if you take something that’s unusually expensive or you need a lot, it can add up. That’s why it’s recommended to go for a supplemental policy as well (Medigap).

You have to pay if you’re late

You have 3 months before your birthday, the month of your birthday and 3 months after your birthday to sign up for Medicare. Some people are being enrolled automatically but not all, that’s why it’s better to check it with Security Service office and do it yourself. If you’re not enrolled after these 7 months, you will have to pay the penalty to enroll later. It’s the same if you don’t decide on a Part D plan for prescription drugs at first but then try to do it when you actually need some medications. If you still work when you turn 65, check your situation with your HR department, as it may be different.

Medigap is not always for everone

When you enroll in a regular Medicare plan, you can buy Medigap as a supplemental policy. It covers some of the expenses that a normal Medicare doesn’t (e.g. copayments, deductibles). You can purchase anything during an open enrollment period, but if you miss it or decide not to, it may be more difficult or even impossible to get the supplemental insurance. In the case when you first choose a Medicare agent plan but you don’t want it in the future, you can leave it within 12 months. If you had Medigap before or you bought a Medicare Advantage plan after your 65th birthday, you will still be able to buy supplemental policies.

There are some limitations that you may not like

Unfortunately, Medicare doesn’t cover some services that are often needed by older people. For example, you won’t be eligible for most of the dental care, unless you have an emergency while staying at the hospital. It also doesn’t cover regular eye exams and eyeglasses, only exams for certain conditions (like glaucoma). Hearing aids aren’t covered by Medicare either. You also won’t be able to get any in-home or nursing home care – you’re covered as long as you stay in hospital. 

But you can get help

Many people don’t know that, but you can get the help of a professional while choosing the best insurance plan or to fight for the expenses to be reduced or annulled. There is a State Health Insurance Assistance Program in each state with counselors who can help you with your problems and doubts. So don’t feel like you have to deal with all of it alone.