The Queens Chronicle’s article, “What Medicare does and does not cover,” explains that Social Security works with the Centers for Medicare & Medicaid Services (CMS) by enrolling people in Medicare. But they’re not the same, and people frequently confuse the two.
A person can apply for Social Security benefits at age 62, with eligibility for Medicare three years later. Initial eligibility begins three months before the 65th birthday, extending through one’s birth month, and continuing for the next three months. New enrollers have a seven-month window with open enrollment for 2017 coverage from October 15 until December 7.
Many people forget to file for Medicare. Sometimes it’s because they’re still working or because they already have another form of health insurance. This can be a costly mistake, along with knowing what Medicare does and doesn’t cover.
Home-care services can become prohibitively expensive and can often quickly deplete one’s life savings.
Medicare pays in full for the first 20 days in a nursing home and then in part for another 80 days. That can leave a patient responsible for a hefty co-payment. In addition, to be eligible, an individual must have a skilled-care need, like physical therapy.
Long-term care insurance might help, as it covers home care, assisted living care, and nursing home care. But many folks can’t get insurance due to the cost or an existing physical condition.
There are two main ways to be covered: original Medicare—Parts A and B—or a Medicare Advantage Plan (Part C). Some choose additional coverage like Medicare Supplement Insurance, which, along with Parts A and B, is also replaced by the Medicare Advantage Plan, or Medicare outpatient prescription drug coverage (Part D).
If you require services that Medicare doesn’t cover, you’ll have to pay for them yourself—unless you have other insurance or you’re in a Medicare health plan that covers them. Medicare covers 80% of medical bills and, to cover the difference, many seniors purchase Medicare Supplement Insurance, which costs around $200 to $300 per month. There’s also a Medicare Advantage Plan, or Part C. This replaces regular Medicare and the supplemental insurance.
Each Medicare Advantage plan can charge different out-of-pocket costs. These can be based on many factors, like whether the plan charges a monthly premium, whether it pays any of Medicare Part B premiums, whether it has a yearly deductible or any additional deductibles, and the amount you pay for each visit or service.
Some insurance companies charge high rates for supplemental coverage, so shop around. Look at several health insurance companies for the best prices.
To enroll, you must see if you’re eligible. If you have other health insurance, you need to understand how Medicare works with that policy. If you’re retired and have coverage from your former employer, you need to determine what happens to the coverage when you’re eligible for Medicare. If you’re retired and have Medicare and group health plan (retiree) coverage from your former employer, Medicare typically pays first for your healthcare bills, and your group health plan coverage pays second.
Reference: Queens Chronicle (October 6, 2016) “What Medicare does and does not cover”