Medicare Parts A and B do not always cover all the expenses necessary for good medical care. These two parts are also known as original or traditional Medicare and assume most of the medical expenses once you reach the age of 65. Part A focuses on inpatient care and covers everything from hospitalizations to palliative care and some specific related home services.
Besides that, Part B focuses on medical care and includes everything from medical consultations, preventive care, to certain related medical equipment and supplies. Medicare subscription is usually enabled for users three months before they turn 65 years of age.
It is true that a private Medicare Advantage plan can offer low benefits and premiums. A recent report by the Office of the Inspector General found that some Medicare Advantage beneficiaries are being denied some needed care, sparking controversy. Let’s review three crucial aspects that Medicare Parts A and B do not cover.
Prescription Drugs: Are They Covered by Medicare?
Medicare does not include prescription drug coverage for patients with outpatient situations, but you have the option of purchasing a separate Part D policy that does cover these needs. You can also opt for a Medicare Advantage plan that includes both medical costs and medications if necessary. You can enroll in Part D coverage or a Medicare Advantage plan at the time of your Medicare enrollment or if you lose other drug coverage.
Additionally, you have the possibility to change your policy during the Open Enrollment season that takes place every fall. Always compare the costs and specific coverage of your medications under a Part D plan or a Medicare Advantage plan using the Medicare Plan finder.
Does Medicare Cover Long-Term Care?
The absence of Medicare coverage for long-term care is a relevant issue that affects the quality of life of many beneficiaries and their families. Let’s try to explain the reasons why the Medicare program does not cover these costs.
As you know, the program covers a wide range of medical services, from hospitalizations to surgical procedures, medical consultations and preventive services. However, long-term care, which includes nursing home care, extended rehabilitation centers, and daily assistance with basic activities such as bathing, dressing, feeding, and other physical needs, is not included in Medicare services.
The reason why Medicare excludes these coverages has to do with the original structure and purpose of the program, which focuses on providing coverage for acute and short-term medical services. Long-term care, on the other hand, focuses on the ongoing management of chronic conditions and permanent disabilities, as well as long-term personal care needs, so it goes beyond the scope of Medicare as set out in the law of its creation.
Unfortunately, to cover the costs associated with long-term care, users must turn to certain strategies such as using their own savings and financial resources, while others opt for private care-specific insurance. Another widely used strategy is to apply for Medicaid, the federally and state-funded health insurance program for low-income people, which can provide coverage for long-term care, although eligibility requirements vary by state. We recommend that you search for Medicaid eligibility information in your specific state of residence.
Are Co-payments Covered by Medicare?
This is a bit complex, but let’s try to explain it easily. First of all, Medicare Part A is responsible for covering hospital stays, while Part B covers medical services and outpatient care. However, it is important to note that beneficiaries are responsible for certain deductibles and co-payments associated with these services. This means that Medicare Part A and Medicare Part B do not exactly cover all the costs.
In the case of Part A, a deductible of $1,632 is established in 2024 before the coverage takes effect. In addition, beneficiaries must pay a part of the cost of extended hospital stays: $408 per day for days 61 to 90 in the hospital and $816 per day after that period. It is essential to keep in mind that over a lifetime, Medicare will only cover a total of 60 additional days beyond the 90-day limit, known as “lifetime reserve days,” after which the beneficiary will bear the entire hospital cost.
On the other hand, Medicare Part B usually covers 80% of medical services, lab tests and X-rays, but beneficiaries must pay 20% of the costs after a $240 deductible in 2024. In this sense, having a Medigap (Medicare Supplement) policy or a Medicare Advantage plan can be essential to cover these gaps in coverage.
Medigap policies, offered by private insurers, come in 10 standardized versions that supplement Medicare coverage, providing help where standard coverage ends. It is important to mention that if a Medigap policy is purchased within six months of enrollment in Medicare Part B, insurers cannot reject the beneficiary or charge you more due to pre-existing conditions.
Meanwhile, Medicare Advantage plans provide medical and drug coverage through private insurers, and may also offer additional benefits such as dental and vision care. In addition, beneficiaries have the option to switch Medicare Advantage plans each year during the open enrollment season, providing flexibility and the ability to adjust coverage based on changing health needs.
