Traditional Medicare works! Researchers looked at 60 million people on traditional Medicare between 1999 and 2013. They found that mortality rates dropped steadily, and people were less likely to end up in the hospital. The improvement comes from a combination of health prevention programs, improved medical technology, and care shifting from hospitals to less expensive outpatient facilities. People who were hospitalized were having much better outcomes. They had a much better chance for survival!
Unfortunately, Medicare doesn’t cover everything. If you need certain services that Medicare doesn’t cover, you’ll have to pay for them yourself unless you have other insurance that covers these services.
Even if Medicare covers a service or item, you will have to pay your deductibles, coinsurance, and or copayments.
Some of the items and services that Medicare doesn’t cover include:
- Long Term Care
- Routine Eye Exam (vision exam or exam related to prescribing glasses)
- Cosmetic surgery
- Hearing aids and exams for fitting them
- Routine foot care
Medicare celebrates its golden anniversary on July 30th. 50 years ago, on July 30, 1965, President Lyndon Johnson signed the Medicare law into effect. The program started in January of 1966, when millions of Americans 65 and older signed for Medicare Parts A & B. It has protected millions of people from poor health, premature death and bankruptcy!
There have been changes made to Medicare since 1965. President Nixon made the first major change to Medicare when he signed a law expanding coverage to include people under 65 with disabilities, and people with End Stage Renal Disease. Years later, it was expanded to include people with ALS.
The next big change came when President George W. Bush signed the Medicare Prescription Drug Improvement and Modernization Act of 2003, which added the optional prescription drug benefit (Medicare Part D).
The Welcome to Medicare visit is not the same as a routine physical exam or annual Medicare Wellness visit. The Welcome to Medicare visit is supposed to be an introduction to Medicare and should focus on disease prevention and detection to help you live a healthier life. It is sometimes referred to as the “Initial Preventive Physical Exam”… or IPPE. The Welcome to Medicare visit is a one-time-only visit covered by Medicare Part B. That means that you don’t have to pay a co-pay or coinsurance — there is no additional cost to you. You have twelve months from the date of your initial enrollment into Medicare Part B to complete the visit.
During your Welcome to Medicare Preventive Visit, you and your doctor should discuss disease education and prevention. Your doctor should also review your medical and health history, such as:
- Past medical/surgical history, such as illness, hospital stays, operations, allergies, and injuries
- Current medications and supplements, including over-the-counter vitamins
- Depression and safety screening
- Family health history
- History of alcohol, tobacco, and illicit drug use
- Physical activities
The visit will also include:
- Measurements for:
- Blood pressure
- Body mass index
- A simple vision test – (Not normally covered by Medicare)
- A written plan for screenings, shots and other preventive services you may need
- In some cases, a discussion about creating an advanced directive
If diagnostic tests or other services are performed that are not covered by the Welcome to Medicare visit, you may be responsible for co-pays and coinsurance.
You should take the following items with you to your visit: Medical records, including immunization records; a detailed family health history; and a full list of medications and supplements, including vitamins.
Medicare Enrollment Periods Explained!
There are five different enrollment periods for Medicare! It’s no wonder everybody gets confused! I will simplify it all for you here.
Initial Enrollment Period: There is a seven-mont Initial Enrollment Period, for people Turning 65 and enrolling in Medicare. It includes the three months before the month that you turn 65, your birthday month, and the three months afterwards. This applies to all forms of Medicare—Parts A (hospital), B (doctor and outpatient expenses), C (Medicare Advantage), and D (prescription drugs).
Medicare Supplement Enrollment: There is a separate six-month open enrollment period for Medicare Supplement policies (also called Medigap), which begins when you’ve turned 65 , or enrolled in Part B. During this period, insurers must sell you any Medicare Supplement policy they offer…no medical questions asked! They can’t charge you more because of your age or health condition. This guaranteed access is very important because if you miss this window and try to buy a policy later, insurers are not be obligated to sell you a policy. You may be turned down for coverage based on your health history or charge you more money.
General Enrollment: If you missed enrolling in Part A or B during the Initial Enrollment Period, there is also a General Enrollment Period from January 1 through March 31 of each year. Waiting until this period could mean lifetime premium surcharges for late Part B enrollment, which can end up costing you thousands of dollars. And your coverage won’t begin until July.
If you enroll in Part B during the General Enrollment Period, there is another period which starts April 1 and goes through June 30—during which you can sign up for a Medicare Advantage plan with or without Part D drug coverage. In most cases, coverage also will take effect July 1.
Part D drug coverage – If you don’t sign up for it when you first can, and later decide you want it, you will face potentially large premium surcharges if you were without coverage for 63 days or more.
Special Enrollment: There are lots of special conditions that can expand your penalty-free options for when you sign up for Medicare, such as employer coverage, or moving (for MA and Part D coverage).
Open Enrollment: If you already have Medicare, there is an Open Enrollment Period every year, when you can select a new Medicare Advantage or Drug Plans. You also have the option of moving back and forth between Original Medicare (Parts A and B) and Medicare Advantage. It runs from October 15 through December 7.
For those with Medicare Advantage plans, there is one more time period you need to be aware of. From January 1 through February 14, there is the Medicare Advantage Disenrollment Period. During this time, you can move back to Original Medicare and also get a Part D plan if you need one..(if your Medicare Advantage plan included Part D coverage.)
It certainly is confusing, but a good insurance agent will help keep you informed, and walk you through the process!
Medicare beneficiaries need to pay a significant portion of their health care costs. Medicare requires beneficiaries to pay premiums, deductibles and coinsurance. But there’s a lot you can do to keep these costs manageable. Here are some steps to minimize Medicare’s out-of-pocket costs.
Premiums: Most people aren’t charged a premium for Medicare Part A hospital insurance. The standard monthly premium for Medicare Part B medical insurance is $104.90 in 2015. This amount is typically deducted from your Social Security check if you are already receiving payments, but those who have not yet claimed Social Security will receive a bill. People with adjusted gross incomes above $85,000 for individuals and $170,000 for couples are charged higher Part B premiums.
It’s important to sign up for Medicare Part B during the initial enrollment period, which is a seven-month window that begins three months before your 65th birthday. Your Part B premiums will increase by 10 percent for each 12-month period you were eligible for Medicare Part B but didn’t sign up for it. If you are 68 when you sign up for Medicare Part B, you will be hit with a 30 percent premium increase every year for the rest of your life, If you didn’t sign up for Medicare Part B at age 65 due to participating in group health insurance through your job, you should sign up within eight months of leaving the job or the coverage ending to avoid the penalty.
Deductibles and coinsurance: The Medicare Part B deductible is $147.00 in 2015. Once retirees meet the deductible, they typically need to pay 20 percent of the Medicare negotiated cost for each service. Any time you have any serious medical issues, that 20 percent is going to be a serious amount of money. If the doctor does not accept “Medicare Assignment”, you could also be hit with an additional 15% (Excess Charges), on top of the 20%. There is no annual limit on out-of-pocket costs with Medicare. Medicare Part A has a $1,260.00 deductible (per benefit period) for beneficiaries who are hospitalized.
Supplemental insurance: Medigap policies are supplemental insurance plans that will pay for the copayments, coinsurance and deductibles of traditional Medicare and sometimes extra services in exchange for an additional premium. “A Medigap policy will cut down your irregular out-of-pocket costs, The Medigap initial enrollment period occurs during the first six months you are 65 or older and enrolled in Medicare Part B. After this period ends, you could be denied the right to purchase a Medigap policy or charged significantly higher premiums based on your medical history.
Preventative care: Medicare covers a variety of preventative care services with no cost-sharing requirements, including a free annual wellness visit, flu shots and screenings for a variety of illnesses. Vaccines and preventative exams are fully covered as well as some outpatient stuff. However, conditions discovered during these preventative care visits could require additional tests or treatments that do have an out-of-pocket cost, sometimes even during a visit that you thought would be completely covered. You will be required to pay for it if another procedure is done.
Prescription drug coverage: You can sign up for Medicare Part D beginning three months before you turn 65. A late enrollment penalty is added to your Part D premium if you go 63 or more days without prescription drug coverage after age 65. Medicare Part D premiums, deductibles, coinsurance, copays and covered medications vary depending on the plan you choose and change each year, even if you stick with your existing plan. You can switch Medicare Part D plans during the open enrollment period from October 15 to December 7. You are allowed to change plans every year without penalty, and I recommend that people do it. Even if your drugs don’t change, the policies of the plan might change. It’s important to examine how your costs and coverage will change each year, and consider switching if you can find coverage that suits your needs at more affordable prices.
Medicare Doesn’t Cover Everything: While Medicare covers many of the services people need, there are a few common medical services that it doesn’t. Medicare won’t pay for eyeglasses, hearing aids or dental care. Most significantly, Medicare doesn’t typically cover extended nursing home stays or other types of long-term care. Things like vision care, eyeglass, hearing aids, dental care and non-prescription drugs, these are all things that Medicare doesn’t cover at all. Those are things that you need to figure out another way to pay for.