Getting older means you’re vulnerable to many types of illnesses and diseases. If you’re nearing the age of retirement, you need to look for options to access health care whenever you need to. Medicare in the US is a godsent help to the elderly with this specific problem.  

Medicare is a kind of health insurance for the elderly to look forward to. In 2020, more than 61 million people used Medicare Advantage plans to access Medicare coverage.

But applying for Medicare doesn’t mean you get access to any type of health care. It just means preventive care, treatments, operations, and medicines are more affordable for you. Knowing what it does and doesn’t cover will help you choose the best Medicare plan for you. This article will give you all the details about Medicare coverage and other facts about it.

Medicare Parts and Coverage: An Overview

Medicare programs have five different parts with different coverage. Parts A and B are known as Original Medicare, while Part D covers prescription drugs. The other two, Medicare Advantage plans and Medigap, are alternatives to Original Medicare.

Medicare Part C, also known as Medicare Advantage plans, varies from state to state in the United States. This means that the plan and the benefits it provides are different across states. 

For example, Florida has Medicare programs with over 170 plans to choose from. Aside from Original Medicare, Medicare Advantage plans in Florida also cover other perks such as:

  • Prescription drugs
  • Vision and dental care
  • Health management
  • Fitness programs

Getting Medicare in Florida also grants you access to their LIS program if you’re also enrolled in Medicaid. This helps you with out-of-pocket Medicare costs like prescription drug costs. Applying for Medicaid in Florida is easy. Be sure to apply for Medicaid aside from getting a Medicare Advantage plan in Florida.

The last part is Medigap, which is supplemental insurance. Plans under this part include out-of-pocket expenses such as deductibles and coinsurance amounts.

Medicare Part A (Hospital Insurance)

This part provides coverage for in-patient treatment in hospitals and skilled nursing institutions. It also covers some hospitals and in-home medical care, depending on specific criteria. This can include:

  • Semi-private rooms
  • General nursing
  • Meals
  • In-patient therapy drugs
  • Additional medical equipment and services as part of your in-patient care

You can pay for this Medicare coverage from your paychecks or your spouse’s payroll tax payments. 

If you’re 65 or older, you can get Medicare Part A with no monthly premiums under the following conditions:

  • You already get Social Security retirement or Railroad Retirement Board payments.
  • You are qualified to get Railroad or Social Security payments, but you haven’t applied for them yet.
  • You or your spouse held a government job that qualified for Medicare.

You also need to pay federal taxes for 40 quarters to be eligible for premium-free options. But even if you didn’t meet this requirement, you can still apply for Medicare Part A, but with charges. If you have fewer than 30 quarters, this will cost you $458 a month. The monthly Part A premium if you paid federal taxes for 30 to 39 quarters is $252.

What’s not included in Medicare Part A?

  • Dental, hearing, and vision care
  • Most dental treatments, including cleanings, fillings, and dentures

Medicare Part B (Medical Insurance):

Medicare Part B is available to anybody who qualifies for Medicare Part A. It covers preventive and medically-required treatments. 

But, you need to pay monthly premium charges to access Medicare Part B coverage. Your payment will be deducted from your check if you receive Social Security benefits. And if not, you will get a bill for your Medicare Part B premium in the mail.

The services you can get under Medicare Part B include:

  • Medical screenings
  • Vaccinations
  • Annual check-ups
  • Transport by ambulance
  • Durable medical equipment or DME

There is a monthly premium for Medicare Part B, which is determined by your yearly income. If your annual income is less than $87,000, you will pay the basic premium of $144.60. This also applies if you have an annual joint income of less than $174,000.

Starting in 2020, the annual deductible for Medicare Part B coverage will be $198. You need to pay this before Medicare can cover your medical expenses.

After paying your deductible, you pay a 20% coinsurance portion of the price for most of your treatments. This includes out-patient therapy, in-patient care, DME, and out-patient care.

What’s not included in Medicare Part B?

  • Hearing aids
  • All expenses associated with these seniors’ eye tests, glasses, and contact lenses

Medicare Part D (Prescription Drugs):

Original Medicare does not cover prescription drugs. These expenses can ruin your financial plan, especially if you rely on a limited income.

Prescription medication coverage is provided via Medicare Part D, which is voluntary. Even if you don’t need prescription drugs, you can get a Medicare Part D plan. Late enrollment for Medicare prescription coverage results in a penalty fee. And you will have to pay this penalty for as long as you have this in your plan. Consider applying for one when you’re first eligible.

What’s not included in Medicare Part D?

  • Medications for anorexia and weight changes.
  • Medications for fertility.
  • Drugs for hair growth or aesthetic reasons.
  • Medications that are used to treat the symptoms of a cold or a cough.
  • Medications for erectile dysfunction.
  • Prescription minerals and vitamins (prenatal vitamins and fluoride preparations are included).
  • Non-prescription or over-the-counter medicines.

Medicare Part C (Medicare Advantage Plans):

If you weren’t able to get Medicare Part D, you can choose a Medicare Advantage Plan. This also applies if you choose to forgo Original Medicare. Most plans under Medicare Part C already include Part A, B, and D benefits. Aside from this, they also cover hearing, vision, dental, and prescription drugs.

Your Medicare Advantage plan costs are determined by the coverage it offers and the state you’re living in. The monthly premiums for Medicare Advantage plans vary from $0 to $400. Florida Medicare Advantage plans have an average monthly premium cost of just $8.28. This is the lowest offer you can get compared to other states.

You may also be charged a coinsurance fee, depending on your Medicare Advantage plan provider. If you have a deductible, you don’t need to pay your Medicare Part B deductible. Make sure to go over every pricing and coverage detail with Medicare advisors.

What’s not included in Medicare Advantage Plans?

  • Long-term care in nursing homes or assisted living facilities is not included. And these can break your bank. The annual cost of assisted living in the United States is $54,000. Nursing homes depend on whether it’s private or semi-private rooms.

Medigap (Supplement Insurance):

Much like Part C, Medigap supplements Original Medicare where it falls short. But, you can’t sign up for Medigap coverage and a Medicare Advantage plan at the same time.

Medicare Part A and Part B copayments and deductibles are covered in part by Medigap. That means that if you travel frequently, Medigap will pay your foreign medical expenses. This is in comparison to Original Medicare, in which you don’t have these benefits. The downside is that the plan does not include vision, dental, and long-term care.

Are You Qualified For Medicare?

With certain exclusions, only those aged 65 and older are eligible for Medicare. Those with end-stage renal disease (ESRD) and younger disabled individuals are also eligible. Those with higher salaries are not qualified for Medicare, even if they pay premium charges. To find out more if you’re qualified for Medicare, you can use the Medicare eligibility tool.

Final Thoughts

In this day and age, your health should be one of your top priorities in life. Healthcare costs aren’t decreasing any time soon. That’s why it’s important to understand your Medicare benefits to reduce these costs, especially as a senior.

You’re not alone when you are perplexed by the complexities of Medicare insurance plans. This article acts as a guide to help you understand what’s included in your Medicare plan. But make sure to consult your Medicare advisors. They can help you review each plan to find the best Medicare Advantage plan for you.