Learn More About How Medicare Works and What It Covers
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Medicare
Medicare is a government-run insurance program that provides health benefits to people who are age 65 or older. It also provides coverage for some people under 65 who have been on social security for longer than two years and are living with certain illnesses or disabilities.
What Medicare Can Do For You
Currently, Medicare covers over 55 million Americans and their families. Medicare can be an important safety net to protect you from health expenses during retirement; however, it can also be a complicated program to understand. That’s why we’ve put together this
Original Medicare
Original Medicare, also known as fee-for-service (FFS) Medicare, is made up of two parts: Part A covers hospital insurance and Part B covers medical insurance. You get these automatically when you turn 65 if you or your spouse have paid 10 years (40 quarters) into the Social Security system.
If you’re younger than 65, you could still be eligible for Original Medicare based on disability or end-stage renal disease (ESRD).
Eligibility
You might already know that if you’re eligible for Medicare, your Initial Enrollment Period (IEP) is a seven-month window that starts three months before your 65th birthday and ends three months after your birthday month. You may have also heard that this is the best time to sign up because it’s when you can get guaranteed coverage with no medical underwriting or waiting periods.
Part A
Part A covers inpatient care in hospitals and certain certified nursing facilities after a three-day qualifying stay. It also covers hospice care at home or in a professional facility, as well as some home health care services. There’s no premium for Part A unless you don’t meet the Social Security requirements.
Part B
Part B covers medically necessary doctors’ visits and outpatient services as well as other medical supplies not covered by Part A. These include durable medical equipment (DME), physical therapy and occupational therapy, ambulance services, laboratory tests, X-rays, and more.
Part C
Part C is available to people who qualify for Medicare Parts A and B, but instead of acquiring Medicare Advantage plans from the government, you purchase them directly from private insurance firms.
Part D
Part D is available to Medicare Part A and Part B beneficiaries who would like help paying for additional prescription drugs that Original Medicare doesn’t cover.
Coverage for Those With a Disability on Benefits
If you are eligible for Medicare due to a disability, your coverage will start either 25 months after the disability began or 25 months after you first started receiving Social Security benefits.
Medicare at 60
The government intends to cut the Medicare qualifying age to 60. The aim of lowering the eligibility age by five years is to give health care to those who are unemployed, have retired early, or do not have employer-provided health coverage.
Who Would Be Entitled to Medicare at 60?
When a person who has lived in the United States for at least five years reaches the age of 65, they are currently eligible for Medicare. As things stand, it looks as though the age limit will be lowered to 60 with no further criteria. So, if the government’s plan goes ahead, millions more Americans could be eligible for Medicare.
Flex Card for Seniors on Medicare
With the flex card, you can use your pre-loaded benefits at any health care provider or pharmacy in the United States. You can keep track of your purchases by logging into your account online and checking your transaction history. At the end of each month, you’ll receive a statement that shows how much you have left to spend on health care expenses for the rest of the year.
Do I Qualify for a Flex Card?
The requirements to get a flex card are simple. First, you must be eligible for Medicare Part A and enrolled in Medicare Part B. Second, you must spend money on private, out-of-pocket health care costs every year—this includes things like over-the-counter products and dental visits not covered by Medicare.
Working Past 65
If you’re not already enrolled and you plan to work past age 65, you should check with your employer’s benefits administrator about their group health plan policies and how Medicare works with them.
Medicare and Employer Group Health Plans
If you have Medicare and an employer-based health plan, Medicare may pay its share of approved services after your employer-based plan pays first. For example, if you’re covered by an employer group health plan and you’re in a union or get benefits from a multi-employer group health plan, you’ll have Original Medicare only if:
Your union tells you that they will provide all your Medicare coverage through the multi-employer trust fund with no other insurance coverage for life – or your spouse or former spouse is a worker whose employment history qualifies them for union coverage.
Medicare Fee Schedule
A Medicare fee schedule is a list of the fees that doctors and other health care providers can charge for covered services. The fee schedule varies depending on where you live and what type of provider you use, but the fees generally fall within certain ranges. For example, if your primary care doctor’s allowed charge for an office visit is $100, they can charge up to $99 or as low as $1 to all Medicare beneficiaries in their practice area who have Original Medicare coverage and are not enrolled in a Medicare Advantage Plan (Part C).
In most cases, if you go to a doctor who accepts an assignment, you won’t have to pay more than 20 percent of the allowed amount for covered services. However, please keep in mind that even if your doctor participates in Medicare, they don’t have to accept assignments on every service they provide. There’s a handy Medicare Fee Schedule Lookup Tool online:
Does Medicare Cover Eye Exams?
How We Can Help You With Medicare
Generally, Medicare Part B covers you for one eye exam every 12 months. Although it doesn’t cover routine eye exams for eyeglasses or contact lenses, it will cover an eye exam if it’s medically necessary to diagnose or treat an injury, illness, or condition.
We’re here to help you make informed healthcare decisions. Our experts can ensure you get the coverage you require and aren’t overpaying for any extras. If you’d like to know more, give us a call, or fill out our online form. We’ll be happy to help you select the best Medicare strategy for your future.