Medicare is the U.S. government-run health insurance program for people 65 and older, as well as for some younger people with certain disabilities. Medicare Part A helps cover inpatient care in hospitals, short stays in skilled nursing facilities, end-of-life hospice care, and certain aspects of home health care. Medicare Part B helps cover doctors’ services, outpatient care, medical supplies (including durable medical equipment), and preventive services.
Read on below to learn more about Medicare policies, including what services it pays for and what you may need to pay on your own.
- What Is Medicare?
- What’s the Difference Between Medicare Part A and Medicare Part B?
- What Does Medicare Pay For?
What Is Medicare?
Medicare is a U.S. government insurance program that provides health care assistance to adults who are 65 years or older. It can also provide coverage to individuals younger than 65 who meet eligibility requirements. People younger than 65 may be covered by Medicare if they have specific disabilities or End Stage Renal Disease.
Medicare is often confused with Medicaid but the two serve different purposes. While they are both government-run programs, Medicaid is designed to provide coverage to those with very limited income and assets, while Medicare is health insurance for older adults. Each state runs its own Medicaid program and benefits differ from state to state.
In some cases, people can be eligible for both programs. For those who have dual eligibility, both Medicare and Medicaid will cover specific aspects of a person’s care and living expenses.
Medicare Eligibility: When Does Medicare Start?
Eligibility for Medicare starts at 65 years old. The Initial Enrollment Period starts three months before the enrollee’s 65th birthday. It lasts for seven months and ends three months after the enrollee’s 65th birthday.
Individuals who miss the 7-month Initial Enrollment Period will have to wait for a certain time to sign up. There will also be a monthly late enrollment penalty fee, which will go up the longer you wait to sign up.
It is best to take advantage of your enrollment period to avoid the late penalty fee. After you sign up and are approved, you will receive a Medicare welcome package.
To sign up for Medicare:
Medicare A, B, C, and D Explained
There are four different parts of Medicare: A, B, C, and D. Each part covers specific services and you can combine multiple parts for better coverage.
- Part A provides hospitalization coverage
- Part B provides medical coverage
- Part C (Medicare Advantage) is offered by private health insurance
- Part D provides prescription drug coverage
Some people will also purchase Medigap on top of their original Medicare. This supplemental health insurance can be purchased through private insurance companies. Its purpose is to help fill the gaps not covered by Medicare, so you’ll have fewer out-of-pocket payments to worry about.
What’s the Difference Between Medicare Part A and Medicare Part B?
Medicare Part A and Part B cover different healthcare needs. These are already part of Original Medicare, which covers hospital and medical expenses. If you would like additional coverage for medications, you can also enroll in Part D for an additional premium.
Medicare Part A
Part A helps pay for inpatient hospital stays, skilled nursing care, home health care, and hospice.
You will automatically have premium-free Part A if you have been in the workforce for over 10 years. Those who don’t qualify will pay a premium starting at $274 and up to $499 in 2022, depending on how many quarters you have contributed to in the past.
Medicare Part B
Part B is for medical coverage, which includes doctor visits, outpatient services, lab tests, preventative exams, and durable medical equipment.
In 2022, the average premium for Part B is $170.10. This amount can increase, depending on your income. Those who earn above $91,000 will have to pay the standard premium with an extra charge.
Some important things to note about Medicare Part A and Medicare Part B:
- Part A is free for most 65 and better individuals who have been employed for at least 10 years.
- If you fail to sign up for Part A during your eligibility period, you may be charged with a penalty.
- In 2022, the Medicare Part A deductible is $1,566 and $233 for Part B.
- If you earn more than $91,000, you will have a higher premium for Part B.
What Does Medicare Pay For?
Medicare covers a wide range of services, including hospital stays, doctor’s visits, and prescription drugs. However, there are some services that Medicare does not cover, such as long-term care, family caregivers, or hearing aids.
Does Medicare Pay for Caregivers?
Yes, Medicare pays for some home health care, which includes physical and occupational therapy, nursing, and caregivers like a bath aide. However, there are certain eligibility requirements and a physician’s order is required. Medicare doesn’t cover 24-hour care at home, private caregivers, or personal care services.
Does Medicare Pay for Assisted Living?
No, Medicare doesn’t pay for Assisted Living Facilities or any other long-term residential care. However, Medicare can cover the health services for those who reside in Assisted Living.
Does Medicare Pay for Dental Implants?
No, dental implants, as well as any other dental services including cleanings, fillings, and extractions, are not covered by Original Medicare. However, some Medicare Advantage plans cover dental services, including dental implants.
Does Medicare Pay for Hearing Aids?
No, hearing aids and hearing exams are not covered by Medicare. For hearing care and tests, a supplemental plan may pay for a portion of the cost.
Does Medicare Pay for Home Health Care?
Yes, Medicare covers qualifying home health care. However, there are limitations. The services must be ordered by a physician and provided through an accredited home health care agency. Those who meet the requirements can be covered for the full cost of their home health care for up to 60 days.
Medicare does not pay for Home Care, not to be confused with Home Health Care.
Does Medicare Pay for Nursing Homes?
It depends. Nursing homes and other long-term care services aren’t usually covered by Medicare. However, there are some exceptions to the rule. While Medicare doesn’t cover custodial care, it can help pay for costs in Skilled Nursing Facilities, as long as it is medically necessary. Skilled Nursing coverage is short-term, under 100 days.
Does Medicare Pay for Eye Exams or Glasses?
No, routine eye exams are not included in Medicare coverage. But, if you have chronic eye conditions like cataracts or glaucoma, some eye care services and eyeglasses or contacts can be covered.
Does Medicare Pay for Cataract Surgery?
Yes, Medicare helps pay for surgical procedures to repair cataracts. However, only basic lens implants are covered. For more advanced operations, you may need to cover some or all of the cost out of pocket. Medicare will also cover a pair of eyeglasses or contact lenses after the surgery.
Medicare helps ease the financial burden of health care. While it covers a large portion of medical expenses, there are limitations. Before deciding on a plan, whether for yourself or a loved one, it is essential to know all the important details to help you make a more informed decision. Planning ahead helps prevent potential problems and unexpected medical costs.
Have you had any experience with Medicare? What were some of the challenges you faced? Let us know in the comments below, and be sure to share this article with your friends and family who might find it useful.
Medicare Frequently Asked Questions:
Medicare coverage will depend on your specific plan. Some of the common medical expenses Medicare pays for are inpatient hospital stays, doctor visits, lab tests, vaccinations, diabetes supplies, drug prescriptions, and home health care.
Medicare doesn’t cover long-term care, cosmetic surgery, dental care, vision, hearing, and foot care. For more comprehensive coverage, you can purchase personalized plans from private insurance companies and combine them with Original Medicare.
No, Medicare doesn’t pay for most dental care. You will have to purchase a Medicare Advantage plan or other supplemental insurance to cover dental care.
Routine eye exams and eyeglasses are excluded from Medicare’s coverage. It will only cover corrective eyeglasses after you’ve had cataract surgery.
Amie Clark, BSW
Aging Advocate and Senior Care Expert
Amie has worked with older adults and their families for the past twenty-plus years of her career. Her senior care knowledge is based on her experience as a social worker, family caregiver, and senior care consultant. Learn more about Amie here.