5 Important Facts to Know Before Starting Medicare

Medicare is a federal health insurance program that provides coverage to millions of Americans who are over 65 or have certain disabilities or medical conditions.

However, getting started on Medicare can be confusing and overwhelming, especially if you are not familiar with the program.

In this blog post, we will discuss five important facts about getting started on Medicare to help you navigate the process more easily.

Enrollment is not automatic

Contrary to popular belief, enrollment in Medicare is not automatic. If you are receiving Social Security benefits, you will be automatically enrolled in Medicare Part A and Part B when you turn 65.

However, if you are not receiving Social Security benefits, you will need to sign up for Medicare during your initial enrollment period, which starts three months before your 65th birthday and ends three months after your birthday month.

There are different parts of Medicare

Medicare is divided into different parts, each of which covers specific services.

  • Medicare Part A covers hospital stays, skilled nursing facility care, hospice care, and some home health care.
  • Medicare Part B covers medical services and supplies, such as doctor visits, lab tests, and outpatient care.
  • Medicare Part C, also known as Medicare Advantage, is an alternative to original Medicare and includes all the benefits of Parts A and B, as well as additional services.
  • Medicare Part D covers prescription drugs.

You can choose between original Medicare and Medicare Advantage

As mentioned above, you can choose between original Medicare and Medicare Advantage.

Original Medicare is the traditional fee-for-service program that includes Parts A and B. You can see any doctor or specialist who accepts Medicare, but you may have to pay deductibles, copayments, and coinsurance.

Medicare Advantage plans, on the other hand, are offered by private insurance companies and provide all the benefits of Parts A and B, as well as additional services such as vision, dental, and hearing. However, you may be limited to a network of providers and may have to pay copayments or coinsurance.

You may need additional coverage

Original Medicare does not cover all medical services and supplies, which is why many people choose to enroll in additional coverage such as Medicare. Here are some of the coverage gaps in Medicare:

  • Prescription drugs: Original Medicare (Part A and Part B) does not cover most prescription drugs. Beneficiaries who want prescription drug coverage must enroll in a Medicare Part D plan, which is a separate insurance policy that covers prescription drugs.
  • Dental, vision, and hearing: Original Medicare does not cover routine dental, vision, or hearing services. However, some Medicare Advantage plans may offer coverage for these services.
  • Long-term care: Medicare does not cover most long-term care services, such as nursing home care. Beneficiaries who need long-term care may need to pay for these services out of pocket or through Medicaid, a joint federal-state program that covers healthcare for low-income individuals and families.
  • Acupuncture and alternative therapies: Original Medicare does not cover acupuncture or other alternative therapies, although some Medicare Advantage plans may offer coverage for these services.
  • Cosmetic surgery: Medicare generally does not cover cosmetic surgery unless it is medically necessary.
  • International travel: Original Medicare does not cover healthcare services received outside of the United States, except in very limited circumstances.
  • Home modifications: Medicare does not typically cover home modifications, such as the installation of wheelchair ramps or grab bars, unless they are deemed medically necessary.

It’s important for Medicare beneficiaries to understand these coverage gaps and explore their options for obtaining additional coverage or paying for services out of pocket.