8 Costly Medicare Mistakes to Avoid

Greg Wilson

Updated on:

8 Costly Medicare Mistakes to Avoid

    Sheila signed up for Medicare, picking a plan with the lowest premium. 

    Her low premium plan, though, had the worst out-of-pocket expenses. Before Sheila knew it, she was paying hundreds of dollars in co-pays.

    Her mistake? Assuming a low monthly premium was the right way to go. Most Americans don't have an extra $250 to spare. So being hit with a hefty copay can be a significant problem.

    When choosing a Medicare program, you have to pick a plan with reasonable expenses. What other costly Medicare mistakes do you need to know about? Read on to find out.

    1. Now Knowing What Medicare Insurance Does

    The first mistake to avoid is not understanding Medicare as a program. What is Medicare anyways?

    Medicare was established by the United States federal government as a national healthcare program. Working as a part of the social security act, Medicare is all about providing Health services for individuals 65 years of age and older. Specifically, Medicare is there to help seniors who don't have any current health insurance.

    Now that you know more about what Medicare does, let's talk about Medicare eligibility and registration. Many people mistakenly think that age is the only criterion for Medicare.

    However, different things can help you qualify to become a beneficiary of Medicare. Controlled by the Medicare and Medicaid Services centers, Medicare also allows people with specific disabilities. For instance, if someone's dealing with Lou Gehrig's disease or the end stage of renal disease, they probably qualify for Medicare.

    2. Thinking Medicare Covers Everything

    A common mistake individuals make is falling under the pretense that Medicare will cover all of their medical needs. However, there are specific services that seniors often need that Medicare will not cover.

    Here's a short list of medical services that Medicare usually doesn't cover:

    • Long-term Care
    • Cosmetic surgery
    • Medical Care outside of the United States
    • Foot Care
    • Eye exams
    • Hearing aids
    • Dental Care
    • Acupuncture

    Routine dental care includes things like fillings and cleanings. Staying on top of your cleanings is the best way to improve your oral hygiene. Dentists say most people need biannual cleanings, while others only need annual cleanings.

    However, Medicare isn't going to pay for routine dental care. Medicare isn't going to cover other types of dental care, such as dentures or implants.

    If you go to the hospital, Medicare part A can help pay for specific dental services. But Medicare part A will only cover those dental services if medically required to get them.

    As far as your eyes go, Medicare won't cover regular eye exams or pay for glasses and contact lenses. In some cases, Medicare will be willing to cover eye exams if you have a specific health condition. For instance, if you're at risk for glaucoma or you need to take a yearly retinopathy exam for diabetes, Medicare may be able to help.

    Even though Medicare isn't going to cover the cost of your glasses or contact lenses, it could help pay for cataract surgery. You could get coverage if you have to get cataract surgery and your doctor uses intraocular lens implantation. It's all on a case-by-case decision for coverage approval.

    3. Ignoring Medicare Advantage Plans

    Understanding Medicare is just the start. Don't make the mistake of overlooking Medicare advantage plans too.

    Medicare Advantage is a type of insurance. It will not be the right fit for everyone because it's expensive. But if you can afford the coverage, it can give you some of the best health insurance benefits.

    What exactly are Medicare advantage plans? They're private health plans. Similar to traditional Medicare, the advantage plans will not replace supplemental insurance.

    You'll enjoy the best coverage while also receiving more services. For instance, you can get part Medicare coverage and Part B Medicare and add it to a Medicare Advantage plan.

    Rest assured, you get the same health insurance equal to traditional Medicare standards. However, you'll get additional benefits and coverage too!

    In other words, you won't be eliminating yourself from traditional Medicare. Instead, you'll be extending your benefits. You'll maintain the same rights and protections the government guarantees traditional Medicare patients.

    To qualify for a Medicare Advantage plan, you'll need to be eligible for Medicare Part A and Part B. You also have to live somewhere where Medicare Advantage plans are available. Specific locations are outside the service range, so individuals in those areas won't qualify.

    When can you sign up for an advantage plan? You'll have to sign up during the yearly election to be eligible for a Medicare Advantage plan. You can also sign up during your initial enrollment.

    4. Using Medicare Plans With Medicaid

    Are Medicare and Medicaid the same thing? Not at all!

    Medicare has two parts, Part A and B. There are also advanced Medicare programs that you can look into.

    Medicaid is an entirely different program altogether. It's up to you whether you want to use original Medicare or see what Medicare advantage has to offer.

    Original Medicare provides inpatient hospital services and outpatient medical services. Original Medicare is designed for older Americans. It helps with inpatient and outpatient medical services.

    Medicare Advantage will help with comprehensive dental, vision, hearing, and more services. But what about Medicaid? Where does it fit into the program?

    Medicaid is a broad program that focuses on helping children, adults, and people with disabilities. You can think of Medicaid for everyone and Medicare mainly for seniors. To qualify for Medicaid, you have to make a specific income.

    The broad Medicaid program is funded by the federal government and our states. The entire goal of Medicaid is to help low-income families have their needs met.

    When comparing costs, you'll find that Medicare is more expensive. With Medicare, you have to pay the deductibles for different services. You also have to pay out-of-pocket costs for prescriptions when you have Medicare.

    5. Missing Annual Coverage Changes

    Medicare isn't a static program. The coverages available and the types of services you can receive can change. It's your responsibility to stay up to date with the latest Medicare benefits so you can get the most out of your plan.

    For instance, did you hear about the recent changes to Medicare Part D? Specifically, the changes affect prescription drug coverage.

    Medicare Part D is a prescription drug plan that's completely optional. The coverage comes with a monthly premium, and you can get Medicare part D coverage as a standalone. However, you can add Medicare part D coverage to your advantage plan that uses medical benefits.

    Starting in 2022, the way you pay your deductibles for Medicare part D coverage will be a little bit different. You'll find yourself spending more before you can start enjoying the benefits the plan offers.

    To avoid falling into a coverage gap, we suggest looking into getting your medication through the mail. Anything you can reduce your out-of-pocket drug cost will be a big help.

    Once you've reached a certain amount of out-of-pocket drug costs, you'll be able to get out of the coverage gap. That's when you'll be able to pay a more reasonable coinsurance for all the other prescriptions you might need.

    We suggest reviewing your drug plan's annual notice of the change. You'll be able to see any changes that took place starting on January 1st of the following year. Then you'll be able to compare the cost versus coverages to decide if the plan is serving you.

    6. Getting a Physical Instead of a Wellness Visit

    Will your annual physical be covered under Medicare? It all depends on the words you use.

    Going in for an annual physical could cause problems with receiving coverage. Going in for a yearly wellness check guarantees you'll get the Medicare coverages you need.

    Every year, Medicare gives you the option to schedule a wellness check. The wellness check is included in your Medicare part B coverage.

    As long as the provider you're going to accepts Medicare, you won't have any charge. During the wellness check, your doctor will evaluate your state of mind and check your vital signs. After reviewing your cognitive skills, you'll be able to get advice for staying healthy in the future.

    If you have a Medicare Advantage plan, you can also schedule a wellness check under it. When calling your doctor's office, let them know to specifically schedule the appointment as a wellness visit. By categorizing the appointment as a wellness visit instead of a physical, you'll be able to get the coverage you need.

    Remind Yourself

    Don't miss your appointment either! Set up your smartphone so that it's easier to navigate your appointments.

    Doing things like setting enrollment reminders would be a great start. For instance, Medicare's annual enrollment will always be from October 15th through December 7th. Your initial enrollment is 7 months.

    The 7-month period begins 3 months before you turn 65 and ends 3 months after turning 65. Keep an eye open for reminders from the social security office.

    7. Assuming Medicare Coverage Doesn't Cover Chemo

    Hopefully, you and your loved ones will never have cancer. However, it can be nice to have peace of mind knowing whether or not your Medicare coverage will help with chemotherapy.

    Another mistake individuals make assuming that Medicare doesn't cover chemotherapy. We're happy to report that Medicare does cover chemo. You'll be able to enjoy coverage for chemo whether you have a traditional Medicare plan such as original Medicare or a private Medicare Advantage plan.

    Both original Medicare and private Medicare Advantage plans cover outpatient and inpatient chemo treatments. However, before you can start receiving a payout for Medicare, you will have to meet your deductible.

    For outpatient chemotherapy, part B will cover around 80% of the chemo cost. For instance, if you get a round of chemo at a doctor's office or a free-standing clinic, Medicare part B will cover 80% of the cost.

    There are special stipulations regarding receiving chemo treatments at a skilled nursing facility. Typically, Medicare will cover a specific number of treatments for a certain period. If additional treatments are necessary, they'll be out of pocket.

    8. Mistaking Podiatry for Routine Foot Care

    Don't fall into the trap of mistaking routine foot care for specialized services. Regular foot care means managing an ongoing underlying foot condition.

    Routine foot care includes filing down calluses, clipping nails, and caring for flat feet. Medicare will not cover most types of regular foot care.

    However, there are ways to receive Medicare coverage for visiting a podiatrist. A podiatrist specializes in helping people with their feet and ankles. If you're having foot problems, a quick trip to the podiatrist could help improve your life.

    Thanks to Medicare part A and part B, you may qualify for inpatient and outpatient podiatric care. If you decide to receive in-home care or go to a specialist office, you'll be relying on Medicare part B.

    Medicare part B can help with coverages related to foot injuries, foot diseases, and diabetes nerve damage. For Medicare coverage to kick in, your doctor must deem the services medically necessary.

    Completely Understanding Medicare Insurance

    From grasping coverages to knowing how to make your plan work, a lot goes into understanding Medicare. Here at Senior Affair, we're dedicated to helping individuals like you find the answers they need.

    Whether you have questions about retirement, aging, diet, or something else, you're in the right place. Our curated blog is highly researched and full of helpful resources.

    Resources like our detailed blog posts are full of helpful tips. For instance, does medicare cover the silver sneakers program? Read our post to find out!

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    If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.

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