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!