Navigating the complexities of Medicare can be confusing. If you’ve become eligible for Medicare, how can you ensure that you understand how it works and what it covers? These misconceptions about Medicare are very common. Knowing the truth behind these common misconceptions can make Medicare less confusing and ensure that you get the coverage you need. 

Medicare is Not Completely Free

Many people think that because Medicare is a government benefit and they’ve been paying into it with taxes that it is free. This is probably one of the most common misconceptions about Medicare. Even though Medicare is funded by a tax trust, you are still responsible for paying certain costs. Expenses you are responsible for include monthly premiums and co-pays for services and prescriptions.

So what is covered and what do you have to pay? Part A is hospital insurance and most people don’t have to pay for this coverage. Part B is medical insurance that pays for necessary services such as doctor’s visits, therapists, and home health care. Most people do have to pay monthly premiums for Part B. Part C is a combination of the other parts of Medicare but it is provided through private insurance companies and can lower your costs and bring you extra benefits. Part D is prescription drug coverage and most people have to pay monthly premiums for Part D coverage. Learn more about the different parts of Medicare.

Depending on your situation and coverage, you can also be responsible for expenses such as deductibles and out-of-pocket costs. There aren’t any annual out-of-pocket limits with Medicare. This means that you can usually expect to pay for around 20% of your medical expenses. These are gaps in Medicare coverage. To help with these gaps, you can add on on a Medicare supplement policy called Medigap. Jim can review the supplement plans with you so that you can know your options.

Medicare Doesn’t Cover Everything

Medicare doesn’t cover every single medical procedure or expense that may come up. There are a wide variety of medical services and expenses that Medicare doesn’t cover. The general rule with Medicare is that it will only cover necessary healthcare, not elective health care. Elective health care that Medicare won’t cover includes out of country health care, hearing aids, routine eye care, routine foot care, cosmetic surgery, and routine dental care and dentures. In rare circumstances where these services are deemed necessary, Medicare may cover them. Jim can talk with you about a complete Medicare Advantage plan and can also recommend separate health insurance coverage for these health care services from a private insurance agency, depending on your needs.

 

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Medicare and Medicaid Are Not the Same

Medicare and Medicaid are two totally separate programs. Some people who qualify for one program won’t qualify for the other. Medicare focuses on care for adults that are 65 and older. Medicaid focuses on low-income families and individuals. Knowing the differences between the two can help you decide what is right for you. In some instances, you may qualify for both programs with dual eligibility.

Medicare is a federally run insurance program that is available to all citizens of the United States that are 65 or older, regardless of income. Younger people with certain disabilities can also qualify for Medicare coverage. Medicare is available through a 4 part program. The costs vary depending on your situation and the plan you choose.

Medicaid is an assistance program that helps low-income people of any age. It is run by both the federal and state governments withing the federal regulations for the program. So the programs can vary a little in each state. Medicaid benefits can cover most or all of health care costs depending on the individual and the programs available within the states.

If you have dual eligibility,  Medicaid will pay for costs associated with Medicare. The amount covered depends on income and other eligibility factors. If you have both Medicare and full Medicaid coverage, you are usually completely covered and won’t have to pay any out of pocket costs.

You Can’t Enroll Anytime You Want

Medicare has an initial enrollment period and yearly enrollment periods for Medicare plans. The initial enrollment period starts 3 months before you turn 65, goes through the month that you turn 65, and then continues through the 3 months after the month you turn 65. If you miss your initial enrollment period, you will have to wait until the next enrollment period opens to enroll in Medicare. Each year, the enrollment period for Medicare is open from October 15 through December 7. If you don’t enroll during your initial enrollment period, you can be subject to paying higher premiums later.


Jim is here to help you with all things Medicare! No matter what your needs are, you can expect him to guide you to the best plan that fits your individual needs. Contact Jim today to learn more about how he can help!