Healthcare Facts: What Don’t You Know About Medicare?

Do you know your healthcare facts? Medicare, which has been in place for more than 50 years now, is a program to help protect American seniors’ physical and financial health after retirement by ensuring they have access to medical care when they need it. Though Medicare is well-known, there is a lot that people don’t know about it.

1. There are several parts to your coverage.

Medicare isn’t one-stop shopping. In addition to signing up for a Medicare or Medicare Advantage plan, you may need to enroll in Medicare Parts B and Part D. These cover medical care and prescription drugs, and if you don’t sign up for them, you risk paying a penalty later. And you may need a supplemental plan for additional coverage, or to help you pay for out-of-pocket costs.

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2. Your coverage may cost more than you think.

With a traditional Medicare plan, there is no out-of-pocket maximum. That means that if you have a serious health issue, there’s no limit to what you might have to spend for your co-insurance.

Medicare Part D does have a catastrophic threshold, which means that after you spend a certain amount out-of-pocket, its catastrophic coverage kicks in. You will still have to pay 5% of the cost of any prescription drugs over that amount.

3. Medicare isn’t just for seniors.

Everyone needs healthcare coverage and Medicare isn’t designed solely for seniors. Some people with disabilities, as well as patients with end-stage renal disease (ESRD), may qualify for Medicare coverage. 

4. Medigap plans aren’t always an available.

During your Medigap open enrollment period you can buy any Medigap policy that’s available to you, regardless of your health.

But after that, you may not be able to get one, and that may be a major disadvantage if something serious comes up and you need expensive services. If you chose a Medicare Advantage plan instead of original Medicare but decide you are not happy with it, you can leave the program within the first 12 months to join or return to original Medicare. If you had a Medigap policy before buying a Medicare Advantage plan or you bought the Medicare Advantage plan when you first turned 65, you will still be eligible to buy a Medigap policy.

5. There is no long-term care coverage.

One of the things people are most surprised by, is that Medicare doesn’t cover long-term care unless it’s associated with a hospital stay and is rehabilitative.

But if you simply need help with the activities of daily living, Medicare doesn’t cover in-home care or nursing home care.

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Medicare doesn’t cover everything. Luckily, those on Medicare can now start saving on out of pocket expenses like prescription drugs, dental, vision, hearing, and more. Over 1 million people have already received their free Medicare Plus Card.

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