Medicare has four parts. At a high level, these parts provide medical insurance coverage as follows:
Part A and Part B are also referred to as Original Medicare. Part C is commonly called Medicare Advantage. It should be noted that dental, hearing, and vision are usually not covered by Original Medicare. Most times, you'll need to get coverage by purchasing an additional policy and paying a monthly premium.
Medicare coverage extends to all 50 states, Washington, D.C., the Northern Mariana Islands, American Samoa, Guam, or the U.S. Virgin Islands.
Medicare coverage pays for various tests and services, sometimes depending on where you live. However, other items and services are covered no matter where you live.
To see a complete list of tests, items, and services covered by Medicare no matter where you live, or if you have Medicare questions, go to www.medicare.gov or call 1-800-MEDICARE.
This is not a "one size fits all" answer.
When you receive notification that you're eligible for Medicare Part A, you'll also be notified that you're eligible for Part B coverage. It is optional and has a premium for all enrollees ($170.10/month for most enrollees in 2022). Part B costs more if your income is more than $91,000 (or $182,000 for a married couple).
If you don't enroll during your initial window, you won't lose Part B eligibility, but you will be penalized with an increased premium when you eventually enroll. This cost goes up 10% for each year you're eligible but don't enroll in Part B unless a current employer's plan covers you.
Medicare Advantage Part C health plans are purchased through private providers who contract with Medicare. Those premiums and levels of coverage vary, so you'll have to do some price comparison shopping before making a decision. The same applies to Part D Prescription Drug plans as well.
Most people are eligible for enrollment in Medicare health insurance when they turn 65. You'll need to meet a few requirements to qualify for various parts of Medicare coverage.
Other factors may influence when you're eligible, such as your health status and your work history. If you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you may qualify for benefits at a much earlier age. Also, you can qualify for benefits if you've been receiving Social Security or Railroad Retirement Board disability benefits for two years.
Original Medicare does not cover routine dental care. Part A and Part B will only cover dental services if required for another medical procedure, and a physician deems them medically necessary, or if they are required as part of a medical emergency.
If you decide to keep Original Medicare, you can purchase a dental plan to pay for cleanings, exams, and other dental care, or enroll in a Medicare Advantage plan with dental benefits. Medicare Supplement plans only extend Original Medicare benefits, so dental coverage would not be included if you purchase this type of plan.
Original Medicare does not cover the shingles vaccine.
However, Part D Medicare Prescription Drug plans usually do. You can buy stand-alone Part D health coverage, or it may be included if you buy a Part C Medicare Advantage plan.
Shingles will affect nearly one out of three people in their lives. Shingles is most common among people over 50, and the risk grows as you age.
Shingles, also known as herpes zoster, is caused by the same virus that causes chickenpox. If you had chickenpox as a child the virus can reactivate and cause painful skin lesions. The most common and lasting complication of shingles is nerve pain. Called postherpetic neuralgia, this type of nerve pain that can last several years after shingles goes away.
If you have a Medicare Advantage or a Medigap plan, chances are some of the costs would be covered.
Cataracts cloud the eye lens and surgery is generally needed to correct the condition. In mild cases, surgery may not be required. If your doctor only recommends corrective lenses but not surgery, then Original Medicare would not cover the cost of the new glasses.
In cases where surgery is required, Original Medicare will cover most of the cost. Because it is typically performed as outpatient surgery, it's covered under Medicare Part B. You will have to pay the Part B deductible, and 20% of the rest of the cost for the cataract surgery based on the Medicare approved fee schedule.
If you need inpatient surgery, Part A will cover much of the costs. Physician services received while you're admitted to the hospital would be billed under Part B, and you would be responsible for the Part B deductible and 20% coinsurance. Part B also pays for corrective eyeglasses or necessary contacts after cataract surgery.
Medicare will also cover the cost of diagnosing and treating many eye diseases and conditions, including:
In most cases, the answer is no. Medicare beneficiaries are required to pay 100% for hearing aids and exams. However, some Medicare Advantage Plans offer extra benefits that may include hearing. Contact the provider or make that a consideration if you're shopping for a Part C plan.
Medicare Part B will cover diagnostic hearing and balance exams in some cases. Coverage is included only if your doctor or other health care provider orders them to see if you need medical treatment. If this is the case, you'll still need to pay 20% of the Medicare-approved amount and the Part B deductible. If testing takes place in a hospital, you also pay the hospital copayment.
This is one of the most common misconceptions about Medicare coverage. Most Americans believe long-term care is covered, but the reality is that it is not.
Medicare may cover short stays in a skilled nursing facility if you've been treated in the hospital for a serious illness or injury, but custodial care in a long-term care facility is not included.
Unfortunately, it's estimated that about 70% of seniors will need long-term care at some point, and that means you'll need to build that cost into your retirement plans or invest in long-term care insurance.
If you choose Original Medicare Parts A and B, there is no limit to your out-of-pocket health care expenses. A Medigap insurance plan is your only protection against catastrophic spending if you choose Part A and Part B.
However, if you choose Medicare Advantage, there is an annual out-of-pocket cap on your expenses. The federal government sets the maximum and in 2022 that amount is $7,550. However, Medicare Advantage Part C plans have flexibility and often set their annual limits much lower. Also, there will probably be a different cap for in-network spending versus care you get outside your plan's network.
Medicare Part D Prescription Drug plans have separate limits set by insurers for capping out-of-pocket costs, and this is something you should investigate if you are considering a Part D plan.
The answer is simple. If you don't pay your premium costs, you risk losing coverage. Medicare Part A is free for most enrollees, but Part B and Part D charge premiums. The same applies to Part C Medicare Advantage plans and Medicare Supplements through private insurance companies.
If you're enrolled in Social Security, your Part B premiums are paid from your benefits automatically, so there's generally no need to worry about missing a payment. You can also arrange to pay your Part D premiums from your Social Security benefits.
If you're not receiving Social Security benefits, you'll need to pay your Medicare premiums directly. The best way to ensure your coverage doesn't lapse is the set up an automatic debit from your checking account or through an automatic credit card payment.
Before Medicare allows your coverage to lapse, you'll receive several reminder notices and warnings. You'll have about three months to bring your account current before your coverage is canceled.
DISCLAIMER: Medi-Solutions Insurance Agency, LLC is not affiliated or endorsed with the Social Security Administration or the Federal Medicare Program. Information is for educational purposes only and should not be construed as an offer of insurance, advice, or recommendation. The information provided is not intended as tax, financial, investment, or legal advice. Please consult legal or tax professionals for specific information regarding your situation.
Other articles:
Learning Center.