Medicare is a health insurance program that affects the lives of many people. Because of the extent of its programs and coverage, many people think Medicare is confusing. However, although Medicare is detailed, it doesn’t have to be confusing. With this guide, you’ll understand the Medicare program better and learn about some of the benefits it may cover for you.
What is Medicare?
Medicare is a health insurance program paid for by the US government. It covers healthcare expenses for most people who are older than 65. It also covers healthcare expenses for people with severe kidney disease and for people who are permanently disabled.
1. Medicare A
There are four parts of Medicare. Medicare A covers your expenses when you stay in the hospital. Under certain conditions. It is provided for everyone who has paid into the Medicare system via premiums deducted from their salary. It also covers your costs when you stay at a nursing home or other inpatient facilities. You don’t have to pay premiums for this part of the plan.
2. Medicare B
This part of Medicare covers outpatient benefits. Medicare B pays for your doctor’s visits, labs, diagnostic tests, and surgical procedures. It can also cover medical equipment like walkers or wheelchairs. You may or may not have to pay for these plans.
3. Medicare C
This part is referred to as a Medicare Advantage plan. It combines your Medicare benefits with an additional private insurance plan. You must pay a copayment to your doctor and part of other medical expenses. As a result, you’ll show both your Medicare card and the membership card from this insurance when going to a doctor’s office.
4. Medicare D
This part of Medicare pays for prescription medication. You can typically go to any pharmacy, and Medicare will pay part – or all – of the cost of your medicines. Private insurance companies sell this insurance. It will cost money but less than the total price of prescriptions.
How To Apply for Medicare
To receive Medicare benefits, you’ll need to apply for them. The paperwork for Medicare is detailed, and you’ll need to submit copies of personal identification documents, including a birth certificate and social security card. You’ll also submit a current W2 tax document and a copy of your current health insurance. Military veterans and active military members must show their service records.
You may need assistance with submitting these documents because the documents require many details. You may often find help at your local library. Most local senior centers offer personal services with Medicare applications. There is also a phone number to call if you still feel Medicare is confusing (listed below).
About Other Healthcare Expenses
There are many expenses involved with keeping yourself healthy. Although the four basic parts of Medicare can cover most of your costs, you can also obtain additional coverage for other healthcare bills. An insurance agent can help you explore any expenses you expect to pay and provide Medicare solutions to fit your individual needs. Depending on the additional provisions and policies you add to your basic policy, here are some of the services which your Medicare policy could cover:
Holistic Physical Therapy
Holistic practitioners often offer alternative medications, like herbal or topical medications. It can sometimes include acupuncture (inserting tiny needles into the body at specific energy points to direct healing energies.) Some Medicare Advantage plans cover some of the services offered by in-network holistic practitioners or cover therapeutic massage. Check your policy to see which services and medications are covered for you.
You may have heard of holistic physical therapy sessions, and wonder what they might include. Like other holistic practices, holistic physical therapy studies your whole body to find the cause of your problem. They then work with your body to help it balance itself and to bring you to a state of healing. Holistic therapy often includes massage, hot or cold applications, or therapeutic exercises.
As with any of the following services, your policy details will determine whether your insurance will cover these services. Don’t allow your belief that Medicare is confusing to keep you from examining all potential insurance policies for complete details before signing up for coverage. When applying for insurance during enrollment, explore all available options before making your final policy decision.
One of the most added health insurance policies by Medicare users is to add dental benefits, like dentist visits. Standard Medicare doesn’t cover most dental services. Medicare A only covers a dental procedure when it’s done as part of a covered hospital procedure. However, some Medicare Advantage policies will cover standard dental services. Although this may be another case where it seems Medicare is confusing, details of covered dental services will be spelled out by your policy.
Your health isn’t limited to your medical problems. If you develop cavities or have other dental issues, it can cause medical problems. Therefore, you should continue to have regular tooth cleaning services at the dentist’s office. Most dental policies cover an annual dental wellness visit, dental x-rays, and dental cleanings. Check with any new dentist to see if they accept your insurance before you make an appointment.
Teeth Whitening and Implants
If your teeth are stained, or their color is uneven, you may want to have tooth whitening services to improve your smile. Unfortunately, Medicare considers this to be cosmetic surgery and therefore designates it as unnecessary. So, your tooth whitening won’t be paid for.
Other dental irregularities may be viewed differently. If you have missing teeth, which are essential for chewing, this can affect your ability to eat and your smile. Despite this, standard Medicare policies will not cover these procedures. Once again, though it may seem Medicare is confusing, check your dental policy – because some Medicare Advantage plans will pay for all or part of the cost of dental implants.
Assistance with Dementia Services
When someone in your family is diagnosed with dementia, it can devastate every family member. Dementia affects the brain and will cause the patient to have progressive memory loss and confusion. Dementia often progresses to the point where the patient has severe agitation and cannot safely care for themselves. Once your family member’s dementia symptoms begin, you’ll want to know which aspects of their care are covered by their Medicare policy as soon as possible.
Any visits to the doctor or labs and tests ordered by the doctor are covered by Medicare B. If the person with dementia goes to the hospital, that’s still covered by Medicare A. Medicines are covered by Medicare D, while other services may be covered by your Medicare C Advantage plan – depending on the provisions of that policy.
Does Medicare Pay for Nursing Homes?
As you can see, these Medicare basics can be applied to most diseases and their care. However, the effects of dementia may often lead the family to decide that someone needs to be placed in a supervised facility. While Medicare will pay for skilled nursing, medication, and therapy services in a nursing home for 100 days after hospitalization, it doesn’t pay for the costs of the person’s room, food, or facility services.
After those 100 days, Medicare no longer pays for the patient’s nursing services – although doctors’ visits and medications remain covered. If the person still needs supervision at a dementia care facility, the family would most likely be responsible for all the costs. However, some families add a long-term care policy to their Medicare Advantage plan – or pay for a separate long-term care policy. Long-term care policies can pay for a patient’s expenses in a dementia care facility.
Mental Health Assistance
Your mental health is essential to your quality of life. It can also influence your physical health, so you may wonder if Medicare covers mental health services. Medicare A will pay those expenses if you need to be hospitalized with a mental health disorder. Medicare B pays for outpatient mental health services, and any psychiatric medication is covered by Medicare D.
The benefits for mental health may be limited to certain providers or may be handled by calling a particular phone number to get an appointment. Before you visit a mental health therapy office, be sure the provider accepts your insurance and check your policy details to find out about visit number limits, copayments, and any other specific provisions or policy limits. Don’t hesitate if you’re momentarily thinking Medicare is confusing; your mental health is essential for a healthy life.
As with most essential industries today, scientists working in the medical field and with medical care systems have been faced with the drive to computerize their procedures. The internet is full of health care information, and more education for patients and their families is added daily. While computer programs for doctors’ offices and hospitals have revolutionized medical record keeping and charting, these don’t directly impact your Medicare payments for services.
However, digital methods of medical testing, medical treatments, and surgery have recently been created and will continue to be perfected. Some health insurance companies embrace digital medical interventions; some do not. When you consider the possibilities offered by robotics for amputees or in artificial voice production for those who can’t speak, you’ll see there are medical advances every day we’ll need to be aware of. Those with cognitive impairments have also found help with haptic learning and cognitive redirection programs.
In addition to new medical procedures, the last few centuries have brought progressive advances in modern medicine development. Keeping yourself informed – with your doctor’s and your pharmacist’s help – is the best way to stop thinking Medicare is confusing. There’s always information for someone who wants to take the trouble to learn. With so much valuable information available, it’s becoming easier to educate ourselves about how to stay healthy.
Physical Therapy Visits
When you need assistance to regain your ability to transfer from bed to the chair, walk, or get to the toilet, your doctor will order physical therapy services. Physical therapy may begin in the hospital and will continue in an inpatient rehabilitation facility, outpatient facility, physical therapist office, or home. Medicare will pay for your prescribed physical therapy services.
The amount paid for specific services, their location, and how long they’ll last will depend on your policy details. With so many options involved, it may initially seem Medicare is confusing, but a nurse case manager in the hospital will help you understand which services you’ll need, and whether you’ll need to pay for part of them.
Your health insurance is designed to help you cover your healthcare costs, but most of today’s health insurance companies have begun to promote and cover services to help you achieve wellness. Wellness has become more prominent over the last few decades as insurance companies try to persuade their clients to participate in activities that will help them achieve their best health. To further clarify the quest for medical wellness, it’s like the holistic approach to health. When you pursue wellness with your healthcare team, you’ll be able to stop thinking that Medicare is confusing – since wellness activities go hand in hand with Medicare’s provision of services to maintain your wellness.
Health insurance companies have always acknowledged the importance of annual doctor visits. Today, they’re often called Annual Wellness Visits, and some insurance companies not only cover the visit cost but offer their clients a small money gift to go to the visit. At these visits, you’ll have a physical exam and lab work. You might also have an x-ray or get checked by a heart monitor.
Before the end of the visit, your doctor will review their findings and share any concerns about your health. They’ll recommend any diagnostic tests you’ll need shortly. This discussion time is a good chance to ask your doctor any questions you have about your health.
Medicare can be your best friend; once you realize it’s not true that Medicare is confusing, and choose to learn more about it. Follow the guidelines above and share your concerns with your family and doctor. If you have any questions, you can call Medicare for answers at +1-800-633-4227.