By: Suzanne Johnson
Millions of seniors across the country get their health benefits through Medicare. While the program does provide access to a wide range of providers through the United States, it doesn’t necessarily offer the comprehensive coverage most people expect.
If you are planning on signing up for Medicare in the near future, there are a few things you need to know.
First, Original Medicare [Part A and Part B], were never intended to cover all of your Medical needs and that is why you could be left paying the bill for things you expected to be covered.
You would think dental care would be a standard service covered by Medicare, but it’s not. Your routine cleanings, fillings, and dentures are services you’ll need to pay yourself. The only way Medicare will pay for dental visits is if the service relates to a medical issue, such as needing an oral exam before having surgery.
Good vision is important but Medicare wont’ pay for you to get your eyes checked and it won’t pay if you need glasses. However, Medicare will pay to screen for and treat certain eye diseases, like glaucoma.
If all you have for your medical coverage is Original Medicare, seeing clearly is going to cost you.
“What,” said many seniors to their spouse. I know you are not shocked that most seniors suffer from hearing loss. Surprisingly, Medicare won’t pick up the bill for hearing aids.
It will only pay for hearing tests if you’re experiencing issues that relate to a specific illness or injury.
Hospital Deductibles & Co-pays
Parts A & B of Medicare leave hospital patients with bills from their stays. Even if you get a Medicare Advantage plan that has no deductible, it still leaves between $300 - $400 per day copay if you are admitted.
For five days in the hospital that could be $1,500 or more that you will need to pay.
Long Term Care
This is a big misconception. Many people think that Medicare will pay for long term care. Long term care is generally custodial in nature – meaning, it doesn’t relate to a specific medical need or condition, but rather pertains to assistance with everyday living.
Medicare won’t pay for care that’s custodial so that means, generally speaking, that home health aides, assisted living, and nursing home care are paid for by you.
What you can do
Thankfully, there are things that you can do that can help bear the financial burden of these things.
First, we always suggest that you are saving money on a regular basis. The more savings you have going into retirement, the better. There are tons of things that come up in retirement from replacing a roof to healthcare costs. So, having savings is important.
In addition to Original Medicare we suggest you consider getting a Medicare Advantage plan or a Medicare Supplement plan. Both of these are offered through private insurance companies, but Medicare Advantage plans do cover some dental, vision, and hearing services. The benefits amount varies between carriers and the area you live. Medicare Supplement plans do not generally offer dental, vision, or hearing benefits.
There are a number of other differences between Medicare Advantage and Medicare Supplement plans so it is recommended you meet with an advisor who understands both and can guide you.
Both of these plans will provide some level of payment for long term care services but only for up to 100 days. After that, it is up to you to determine how those bills will be paid.
Let me address the hospital copay. If you get onto a Medicare Supplement plan you will likely not have to worry about the $300 - $400 a day copay. If a Medicare Advantage plan is ideal for you but you are still worried about that copay bill, you can get a separate plan for around $30 - $40 a month that will cover that copay, so you won’t have a hospital bill.
Let’s address that last issue we discussed: Long term care. You will likely have help for the first 100 days, but you need something for after that. Traditional long-term care insurance can be expensive and difficult to qualify for.
That is why you should consider a short term plan [much easier to qualify for and less expensive] or a home healthcare plan [even easier to qualify for and even less expensive] so you have some kind of protective in the event you need some kind of care. With some home healthcare plans they reimburse you for taking your medications, so some people end up getting a reimbursement for an amount that is nearly the same as the premium.
So, there are things you need to plan on paying for when you go onto Medicare unless you have the right plans to go along with it.
Medicare can be confusing but we are here to help make the complicated simple for you.
ABOUT THE AUTHOR: Suzanne Johnson is an insurance advisor in Spartanburg, SC with a strong emphasis on Medicare. Her years of experience and knowledge make her a true value to her clients. “I love to help people and insurance is now the best way I know how to. I teach people how to protect themselves and their loved ones by addressing the difficult decisions that need to be made now before the unexpected happens. I love giving back to my community that nurtured me.”