Traditional Medicare doesn't cover vision and dental

"Traditional Medicare doesn’t cover common dental procedures, such as cleanings, fillings, extractions, dentures, dental plates and other dental devices. Medicare also doesn’t cover the cost of eyeglasses, lenses or contacts" writes Richard Conner in the Humble Dollar Blog:

https://humbledollar.com/2023/08/what-medicare-misses/?utm_source=mailpoet&utm_medium=email&utm_campaign=another-ses-test_7

Pay attention to your dental and vision health before retirement. 

If your employer funds all or part of your dental and vision insurance, use those benefits to their fullest before you retire

"Fund a health savings account, or HSA, during your working years. You get a tax deduction for the amount you contribute, you can invest the money you save, and the earnings grow tax-deferred. When the money is used to pay for qualified medical expenses, the withdrawal is also tax-free."

"Some Medicare Advantage plans provide dental and vision coverage. What if you choose traditional Medicare? Consider purchasing private dental and vision insurance."

In his article Conner provides extensive suggestions and information if you need to buy private coverage. 

Medicare Advantage vs. Traditional Medicare

 One of the most important decisions older Americans need to make when they reach 65 (or older if still covered by employer health insurance) is traditional Medicare or Medicare Advantage.Once you reach age 65 almost all Americans are covered by Medicare Part A at no cost. But you need to supplement that coverage.

The primary argument in favor of traditional Medicare is the broad acceptance. You can get care from any facility in the U.S. that accepts Medicare payment. With most Medicare Advantage Plans you are limited to designated service providers that participate in that plan. 

Due to the coinsurance and deductibles with traditional Medicare, you really need to buy a supplement plan and prescription drug coverage (Part D). If you aren't taking prescription drugs when you sign up and decide to skip a Part D plan, you will pay extra if you wait to sign up.

Some Medicare Advantage Plans offer coverage with a $0 monthly premium which can seem very attractive but you need to do your homework and decide on your personal priorities. Whether or not you pay a premium, Advantage plans typically cover eye, hearing and dental exams and dental exams as well as memberships in athletic facilities and other benefits not included in traditional medicare. 

 Check out the

AARP Medicare Enrollment℠ Guide 

https://www.aarp.org/membership/benefits/health/aarp-medicare-enrollment-guide/

and comments pro/con on each option:

https://humbledollar.com/voices/which-is-better-traditional-medicare-or-medicare-advantage/

Time to Compare (and possibly change) Medicare Plans

The annual period for switching Medicare plans is Oct. 15 to Dec. 7. Only 30% of Medicare beneficiaries shop around annually. BUT... they really should compare options every fall.

    Medicare recipients have the option of traditional Medicare + a Medigap policy + Part D drug plan OR a Medicare Advantage Plan. The main difference is that traditional medicare offers access to any providers that accept Medicare while Advantage plans, sold by insurance companies, are essentially a Preferred Provider program that limits participants to the network's doctors and facilities. 

    Medicare Advantage plans typically cover hearing, eye, and dental care that are not covered by traditional Medicare. Further, Advantage Plans often offer free access to fitness clubs and other benefits focused on keeping participants healthy.  

    Having recently compared AARP/United HealthCare Advantage plans, one with a $39/month premium to their $0/month premium (not a typo) I was shocked to see how similar the plans were despite the cost difference.  

Review your options each autumn!

Medicare Eligibility for People With Disabilities

 Many people think of Medicare as a program for people who are 65 and older. While this is true, some may not know that a younger person with a disability can also qualify for Medicare coverage. Not every disability is a qualifying one, so it’s important to understand if you meet the requirements before you take the time to apply. The following guide is for people under the age of 65 who have questions about whether or not they might be eligible for Medicare.

To help highlight this program for those under 65 with disabilities,  a comprehensive guide to understanding eligibility, coverage, and, how to navigate the enrollment process is available:

https://www.medicareplans.com/medicare-coverage-for-people-with-disabilities/

 

Some of the information available at this website:

Even if you’re under the age of 65, you can qualify for Medicare if you have certain disabilities. You may be eligible for Medicare coverage if any of the following apply to you:

• You have amyotrophic lateral sclerosis (ALS): If you have ALS, often referred to as Lou Gehrig’s disease, you may qualify for Medicare if you receive Social Security Disability Insurance (SSDI) benefits.
• You have end-stage renal disease (ESRD): If you have ESRD, you may qualify for Medicare if you receive regular dialysis or your doctor determines that you need a kidney transplant.
• You’re receiving SSDI: To qualify for SSDI benefits, you must have enough work credits from contributing to Social Security. You must also meet the definition of a disability under the Social Security guidelines. The Social Security Administration (SSA) considers you to be disabled if you can’t do the work you used to do because of your medical condition, you can’t perform other work due to your medical condition, and your disability is expected to last for at least 12 months or result in your death.
• You’re receiving disability benefits from the United States Railroad Retirement Board (RRB): If you’re under the age of 65, you may qualify for Medicare if you’ve been receiving monthly RRB disability benefits due to a total disability for at least 24 months. You must also meet the definition of a disability under the Social Security guidelines.
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Medicare Surcharges

 What you need to know about medicare surcharges by Tim Parker Updated December 04, 2021

• You’ll pay Medicare surcharges, as well as premiums for Part B and Part D coverage, if your household has more than $182,000 in income combined, or $91,000 if you’re single.1
• Medicare surcharges are also called "Income-Related Monthly Adjustment Amounts" (IRMAA).
• The Social Security Administration determines your Medicare surcharges based on your modified adjusted gross income (MAGI) from two years ago.
• You can enroll in a Medicare Advantage plan (Part C) or a Medigap policy, or you might do some tax planning to reduce your MAGI to avoid paying some Medicare surcharges.

Read the details: https://www.thebalance.com/what-you-need-to-know-about-medicare-surcharges-4173033

 

On Medicare and need therapy? Good luck (sigh)

 "Therapy on Medicare isn't easy to find" is the title of Andrea Petersen's article  (11/17/21) in The Wall Street Journal. Briefly... many patients age 65 and older are out of luck when needing therapy due to the very few practitioners who accept Medicare reimbursement. "The reasons therapists decide not to participate in Medicare are similar to why some don't take private insurance plans either: Therapists say reimbursement rates are too  low and the paper work is too arduous."

"Therapists suggest making plans for mental-health care months before your 65th birthday. Ask your therapist if they accept Medicare or would be willing to enroll in the program. Or seek a therapist who accepts Medicare. Telehealth may be an option so you can access a larger pool of therapists from beyond your region. Larger practices and hospital-based clinics are more likely to accept Medicare. 

So don't wait to find the care you expect to need. Ask your current therapist for help finding the care you need.

Home Modifications Covered by Medicare and Medicaid

"Walk-in tubs, hospital beds and wheelchair ramps are among the many home modifications and devices keeping seniors safe. They don’t come cheap, but government programs such as Medicare and Medicaid can defray the cost."

"Medicare is extremely strict about what it covers, but seniors who show medical necessity qualify for up to 80% coverage. Seniors using their hospice care benefit don’t have to pay anything for covered equipment. Meanwhile, a few Medicare Advantage plans offer limited support for home modifications."

"Medicaid is more flexible, with many programs routinely offering medication dispensers and personal emergency response services."

Get the details at: https://www.theseniorlist.com/research/medicare-benefits-home-improvements/

 

Understanding the different parts of Medicare

Three Key Medicare Decisions

"While not an overly complicated benefit, initially signing up for Medicare can be an overwhelming and anxiety-inducing process" according to John S. Traynor | Jun 16, 2021 quoting from his article: https://www.wealthmanagement.com/retirement-planning/three-key-medicare-decisions

• Part A (hospital coverage) covers things like inpatient hospital stays, some home health care, skilled nursing facility care and hospice; requires no out-of-pocket annual premiums; but has both annual deductibles and copays.
• Part B (medical coverage) covers things like doctor visits, outpatient services, X-rays and lab tests, as well as preventive screenings; carries both annual deductibles and copays; and requires monthly premium payments.
• Part C (Medicare Advantage) is a private all-in-one alternative to Medicare that covers the services associated with Parts A and B (and usually Part D). On the plus side, these bundled plans tend to be more affordable and may offer broader coverage (for example, vision, hearing and dental. Providers must be Medicare-approved. But the plans typically come with greater restrictions, and most plans act as HMOs and require plan participants to go to their network of doctors and health care providers.
• Part D (prescription drug coverage) is an optional add-on prescription drug coverage that requires monthly premiums, annual deductibles and copays. Your client will need to enroll in an approved plan and be covered under both Medicare Parts A and B (or Part C).
• Medigap is offered by private insurers to help fill any coverage gaps in Part A and Part B such as copayments, coinsurance, deductibles and potentially foreign travel health emergencies. There are 10 different types of Medigap plans—some cover more out-of-pocket costs than others.

2021 Medicare Premiums

 In 2021, Higher Medicare premiums will apply for individuals with modified adjusted gross income above $88,000; for married couples who file a joint tax return, that amount is $176,000. These higher premiums affect only about 8% of beneficiaries. 

Most Medicare participants will pay $148.50 per month per person.