7 Medicare Facts You May Not Know
November 17, 2021 | Tom Peterson
When you’re enrolling in Medicare or choosing a new Medicare plan, it’s important to understand the options and process. However, we know that Medicare can be confusing! To make it easier, we’re sharing some lesser-known Medicare facts that will help you better navigate the system, courtesy of WebMD.
7 Medicare Facts You Should Know
You’ll Have to Make Choices
When you’re looking into plans, you’ll see that Original Medicare isn’t the only option available. You can choose Original Medicare (Parts A and B), a Medicare Advantage Plan (Part C) or a supplemental policy (a Medigap plan). Both types of plans help with out-of-pocket costs. If you choose Original Medicare, you’ll also need to choose a Part D plan for prescription drug coverage.
It Might Cost More Than You Think
With Original Medicare, there is no out-of-pocket maximum. That means that if you have a serious health issue, there’s no limit to what you might have to spend for co-insurance (the percentage of your medical charges that are your responsibility).
Medicare Part D (prescription drug coverage) does have a catastrophic threshold. That means that after you spend a certain amount out-of-pocket, catastrophic coverage kicks in. But you’ll still pay 5% of the cost of any prescription drugs over that amount. Supplemental (Medigap) policies can help you bridge the cost gap.
If You Delay, You May Have to Pay
Initially, you have 7 months to sign up for Medicare. That period includes the 3 months before you turn 65, the month of your birthday, and the 3 months following.
Some people will automatically be enrolled in Medicare Parts A and B, but others must sign up. If you’re not automatically enrolled and don’t enroll in a plan during your initial enrollment period, you will pay a penalty for enrolling later. This penalty will occur every month you have Medicare. The same is true if you delay enrollment in a Part D plan.
This penalty doesn’t apply if you have creditable coverage through your employer. But some employers may require you to enroll in Medicare when you become eligible. Check with your HR department for more information.
You Can’t Always Get a Medigap Plan
A Medigap policy acts as supplemental insurance to Original Medicare. It pays some of the costs that Medicare doesn’t, such as copayments and deductibles.
During your Medigap open enrollment period, you can buy any Medigap policy that’s available to you, regardless of your health. But after that, you may not be able to get one, and that may be a major disadvantage if something serious comes up and you need care.
If you chose a Medicare Advantage plan instead of Original Medicare but decide you are not happy with it, you can leave the program within the first 12 months to join or return to original Medicare. If you had a Medigap policy before buying a Medicare Advantage plan, or you bought the Medicare Advantage plan when you first turned 65, you will still be eligible to sign up for a Medigap policy.
Dental and Vision Coverage Is Limited
Medicare doesn’t cover most dental care, unless you have an emergency dental procedure while you’re staying in a hospital. It also doesn’t cover routine vision exams. Eye exams for certain conditions, such as glaucoma and macular degeneration, are covered.
Hearing aids also aren’t covered. You’ll need supplemental insurance or a Medicare Advantage plan to help with those costs.
There Is No Long-Term Care Coverage
One of the biggest surprises for many people is that Medicare doesn’t cover long-term care. The exception is when care is associated with a hospital stay and is “rehabilitative,” such as therapy to help you walk again after knee surgery.
You Can Get Help
You don’t have to figure out Medicare facts on your own. You can always contact Twin City Underwriters’ licensed insurance brokers for questions or support.
Choosing a Medicare plan can be difficult. Working with an insurance broker can help you find a plan that fits your needs. Schedule a one-on-one meeting with one of our Minneapolis insurance brokers to get your insurance questions answered!