When it comes to Medicare, all people usually have are “questions.” Unfortunately, it is still very difficult to navigate for most people, and I’m talking 99 percent. The fact is that Medicare has too many moving parts that make it feel like you are a third grader trying to attempt astrophysics equations. Okay, maybe not that bad, but the initial intro feels that way to most. Below are the most asked questions we are going to try to demystify.
Let’s start with the most obvious…
1. What Is Medicare?
Well, Medicare is a lot of things, and it has lots of twists and turns, but we all know it’s some sort of health insurance. Right? A lot of people are confused about what it actually may be. Let’s start with the basics.
- Part A: Pays for hospitals and inpatient care. As of 2022, Part A has a deductible of $1,556, and you pay 20 percent after the deductible with no max out of pocket. There is no premium for Part A if you qualify.
- Part B: Helps pay for doctor’s visits and outpatient care. As of 2022, Part B has a deductible of $233. Your responsibility is still 20 percent after this deductible, and it carries a monthly premium of $170.10 in 2022.
You are eligible for Parts A & B if you are at least 65 years of age, or under 65 with a disability or other special situation, and you are a U.S. citizen or legal resident who has lived in the U.S. for at least 5 consecutive years. You or your spouse will also have had to work and pay into Medicare for at least 10 years.
This leads to the next question.
2. What Do The Parts Of Medicare Mean?
We have gone over parts A and B, now we will lead a little further into the rest of the alphabet: parts C and D.
- Part C: Otherwise referred to as an Advantage Plan, Part C combines Parts A and B into one plan under a private provider and typically offers additional services not offered by Original Medicare (dental, vision, hearing, etc). The plans usually look and feel like your typical health insurance plan because they are and act much like your group health insurance and have HMOs and PPOs typically available.
- Part D: This is the simplest part, just remember “D” for drugs. Part D covers the prescription part of your plan, and oddly enough, D is usually included with C. Confused? Well, this leads to my next question.
3. Do I Need Prescription Coverage With Original Medicare?
The short answer is, yes. You will need to have some sort of prescription drug coverage, Part D, if you want to avoid the late enrollment penalty. Again, Part C usually has Part D built into it. The only situations where you should buy a separate Part D policy is when you elect to stay with Original Medicare (rare) or choose a Medigap policy otherwise known as a Supplement.
4. Supplement Vs. Advantage?
I highly recommended speaking with a broker about the specific difference between these policies, but here is a broad overview. A Supplement is just that — a supplementary plan to your Original Medicare Parts A and B. In most cases, you just pay the Part B deductible, and these plans take care of the rest of the medical bills. Supplements usually have a higher monthly premium than the Advantage plans and require an additional stand-alone drug plan that may have a deductible.
Advantage plans are private health insurance plans that have copays and coinsurance. They usually have a lower monthly premium and no Part D deductible. Advantage plans usually have additional benefits such as dental, vision, and hearing coverage built into the plan. Some plans even include other benefits like gym memberships, meal plans, electronic alerts, etc.
5. Does Medicare Cover Dental & Vision?
Original Medicare doesn’t have any dental or vision coverage. A lot of Advantage plans include additional benefits as mentioned above. If you elect to get a Supplement, you will need to purchase a separate dental and vision plan. For more details, take a look at the specifics in 7 Things To Consider When Choosing Dental And Vision Insurance In Retirement.
6. Do I Have To Take Medicare?
There is a situation where you do not have to elect to go to Medicare. If you work for an employer that has creditable coverage (most do) and more than 20 employees, then you can stay with your employer plan for as long as it is offered to you.
If your employer has fewer than 20 employees, then they can stop offering you a plan at age 65. They rarely remove this option, but they can. The good news is that typically Medicare is a lot less expensive than group coverage. Just be sure to check your medicine before the switch. Copay and discount programs aren’t available to Medicare recipients.
7. Does Medicare Cover Hearing Aids?
Again, Original Medicare does not have a lot of extra benefits above just medical. It will cover the doctors, testing, and treatment if there is a hearing-related medical condition, but as far as hearing aids or fitting goes, there is no coverage. Advantage plans usually cover additional hearing benefits and aids. How much they pay would vary by plan so check with your broker for the best plan for you.
8. What’s The Difference Between Medicare And Medicaid?
This question is more common than I ever expected. Heck, I even get them verbally confused daily! Medicare is for those 65 and over or persons with disabilities. Medicaid is for those who need more financial help and is offered to people of all ages. They are often offered together to help people with both situations.
A lot of people have financial concerns in retirement, and the Medicaid program, in my opinion, is not used enough in the 65+ arena. In some situations, Medicaid will even pay all of your medical expenses including your part B premium. Again, speak with your broker for assistance with these programs.
9. Does Medicare Cover Cataract Surgery?
This feels a bit lacking but… yes — if it is medically necessary and the doctor accepts Medicare. If you are looking for something more experimental other than an original cataract surgery, then double-check with your provider.
10. What Vaccines Does Medicare Cover?
Contrary to popular belief, vaccines are covered under Part D. So in order to get those vaccines and immunizations, you must have Part D coverage. The vaccine must also be part of the plan’s formulary. In most cases, it will cover 100 percent of the vaccine if it is in this formulary after the plan deductible.
Part B does cover some vaccines such as Influenza vaccines, pneumococcal vaccines, and Hepatitis B vaccines. It will also cover direct contact vaccines like tetanus or rabies.
11. Does Medicare Cover Assisted Living?
This question is usually asked far too late. Assisted living communities are an amazing option for those that still want to remain relatively independent and have a doctor close by, but they can get expensive. Regrettably, Medicare does not cover any cost of assisted living. If the doctor at the facility is covered by the plan those medical expenses will be covered but nothing will be covered on the custodial side of care such as room and board.
In the case of skilled nursing, Original Medicare will pay for 100 percent of your first 20 days and then 80 percent of all days after that. A supplement will cover 50-100 percent of the cost of skilled nursing after the Part B deductible depending on your plan. The Advantage Plans are a bit more strict about skilled nursing as they are managed by a provider. Usually, they do everything in their power to get you out of skilled nursing facilities, so if you want to elect to stay in a skilled nursing facility, you are better off with a Supplement or Original Medicare.
12. Do I Have To Apply For Medicare?
If you have already elected to receive social security benefits, then chances are you have already applied for Part A. In most cases, you will have to apply separately for Part B benefits. In order to get a supplemental or an advantage plan, you will also need to get Part B. You can check your status and apply by logging into the Social Security Administration website.
There you have it! I hope this clears up some of the questions you may have about Medicare. There are still a lot of questions I’m sure you may have. It’s always a great idea to find a local Medicare broker to go over your options and clear up the Medicare alphabet. Everyone has a different situation when moving to medicare, so make sure you are covering all of your bases. You can also go to the official Medicare Website for additional great resources.
