Navigating Medicare Benefits for Seniors
If you’ve turned 65, you’ve probably signed up for Medicare. Many Americans believe Medicare will cover all of their medical expenses as they head into their later years. But the truth is much more complicated than that. So, how do Medicare benefits for seniors work?
Medicare is a government health insurance plan available to Americans aged 65 or older and some people with qualifying disabilities. If you have signed up for Medicare recently or expect to soon, it’s time to learn more about it.
Doug Fir Billing provides expert medical billing, including Medicare, for your practice so that you can focus on your patients, not paperwork. Reach out today to learn more about how we can help your practice run more efficiently.
Medicare vs. Medicaid
Before we dig into the ins and outs of Medicare, we need to make sure we’re all on the same page. Medicare and Medicaid are two different types of insurance.
Understanding Medicare benefits for seniors can be confusing.
Medicare is available to Americans who are at least 65 years old or have a qualifying disability. Medicare coverage is provided uniformly throughout the US. If you live in Idaho when you sign up and later move to Arizona, your coverage goes with you.
Medicaid is available to people with limited income and resources. Children, people with disabilities, and adults with earnings below a certain level may be eligible. Each state has its own Medicaid program, and eligibility can vary from one state to the next. If you are planning a move, do some research first if you’re counting on Medicaid.
What Medicare Benefits for Seniors Are Available?
Medicare’s primary purpose is to provide medical insurance to people who have retired or become unable to work due to a disability. This insurance coverage has four parts, adding to the confusion for people trying to navigate their benefits. Let’s look at each of these sections.
Medicare Part A covers home health services.
Medicare Part A
Part A covers inpatient care which can include:
Hospital Stays
Skilled Nursing Facility - This only applies if you need skilled medical care, such as wound care.
Home Health Care - This can include things like occupational therapy. It doesn’t cover personal care, such as assistance with bathing or eating.
Hospice Care
If you or your spouse paid Medicare taxes for ten years or more, you are eligible for this benefit starting at age 65. Medicare Part A does not usually have a monthly premium, but it doesn’t necessarily cover everything. Part A plans generally have deductibles and coinsurance, so you should expect some bills from your healthcare facility.
Part A is generally premium-free if you meet any of the following criteria:
You are at least 65 years old, and you or your spouse worked and paid Medicare taxes for at least ten years.
You are collecting Social Security or Railroad Retirement benefits.
You are eligible for Social Security or Railroad Retirement benefits, but you haven’t started receiving them yet.
You or your spouse receive Medicare through government employment.
Medicare Part B covers items such as walkers and wheelchairs.
Medicare Part B: Medical Insurance
Medicare Part B covers medically necessary services and preventive services. Some of the items Part B covers include:
Doctor Visits
Durable Medical Equipment - This includes things such as wheelchairs, walkers, and infusion pumps.
Ambulance Services
Outpatient Care
Flu Shots and Other Vaccinations
Preventive Screenings
Part B also provides coverage for a limited number of specific prescription medications. Please note that Medicare Part B does not cover most prescriptions.
Medicare Part C: Medicare Advantage Plans
Medicare Part C is also called the Medicare Advantage Plan. This type of plan goes through Medicare-approved private insurance companies.
Medicare recipients can choose to purchase a Medicare Advantage Plan to obtain coverage for additional services. Premiums vary from one plan to another, and the private insurer may offer dental, vision, or other benefits. They will also administer your Part A and Part B benefits. Frequently, they also offer prescription drug benefits (Part D).
Navigating Medicare benefits for Seniors may be easiest with the help of a broker.
There can be numerous differences between one Part C plan and the next. Check the program out-of-pocket costs, pre-authorization and referral requirements, and participating providers before signing up. Working with a licensed broker can simplify this process for some people.
Medicare Part D: Prescription Coverage
Medicare Part D is an option offered by private insurance companies for an additional premium. Part D plans provide coverage for prescription medications. You need to have Medicare Parts A and B in order to sign up for Part D.
If you have prescription coverage through a Medicare Advantage Plan (Part C), you cannot sign up for Part D. You are only allowed one prescription policy. If you choose an Advantage Plan that doesn’t offer prescription coverage, you can sign up for a Part D plan.
Obtaining Medicare Coverage for Seniors
Once you start collecting Social Security, Medicare Parts A and B will automatically begin when you turn 65. But you will need to actively sign up for Parts C or D.
When you turn 65, Medicare Parts A and B kick in automatically.
If you haven’t retired yet to collect SS benefits, you have a window of three months before and three months after your birthday month to sign up.
Pay attention to this timing! If you don’t sign up within that time frame, you could end up paying permanent penalties. Your Part B premium will increase by 10% for every 12-month period you could have signed up but didn’t. That extra fee will continue for as long as you have your Part B policy.
When you’re ready, you can apply for Medicare online through Social Security.
Medicare Doesn’t Cover Everything
While Medicare covers many medical expenses, there are some things it excludes. You should plan alternative payments for items such as the following:
Chiropractic Care
Eye Exams
Hearing Aids
Glasses
Assisted Living Facility
Dental Care
Podiatry
Navigating Medicare benefits for seniors can be confusing. If you have any doubts, ask your primary care provider about whether your care is covered.
Be sure to clarify what is not covered under Medicare benefits for seniors.
Doug Fir Billing Can Help You Make Sense of Medicare Benefits
If you provide care to patients with Medicare, your practice can benefit from professional billing. At Doug Fir Billing, we know the ins and outs of Medicare claims so that you get the payments you deserve and can offer the care your patients deserve.
Spend your time doing what you do best, and let us take care of the billing. Reach out today to get started.