More than 65 million individuals across the United States are currently enrolled in Medicare, which is a federal health insurance program designed for adults aged 65 and above, as well as those with specific disabilities like end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) [1]. While Medicare is widely recognized for its coverage of hospital stays and doctor visits, it also offers various other benefits to its beneficiaries.
Having a comprehensive understanding of all the services covered by Medicare can empower beneficiaries to make better decisions regarding their healthcare needs. Exploring the lesser-known covered services of Medicare and understanding how to access these benefits can greatly assist individuals in maximizing the advantages offered by this program.
What is Medicare?
Medicare was initially designed to offer affordable healthcare to elderly individuals in the United States. Over time, its scope has broadened to encompass younger people with specific disabilities and medical conditions. Medicare consists of distinct parts, each catering to different healthcare services:
Medicare Part A (hospital insurance) covers expenses related to hospital stays, hospice care, home health services, and skilled nursing facility care.
Medicare Part B (medical insurance) covers outpatient medical costs, such as doctor visits, preventive care, and durable medical equipment.
Medicare Part C (also known as Medicare Advantage) is an alternative to Original Medicare (Part A and Part B) provided by private health insurance companies. It includes benefits from Parts A and B, along with additional coverage like vision, dental, and hearing care, varying by plan.
Medicare Part D handles prescription drug coverage.
Medicare Supplement Plans (also called Medigap) assist in paying for expenses not covered by Original Medicare, catering to individuals who opt not to enroll in a Medicare Advantage plan.
Recipients of Original Medicare are responsible for several fees, including an annual Part B deductible, a monthly Part B premium, and various additional costs related to both Part A and Part B, depending on the healthcare services utilized within a calendar year. As of 2023, the Part B annual deductible stands at $226, and the standard monthly premium for Part B is $164.90.
Four Amazing Things Medicare Covers
Navigating the plethora of benefits offered by Medicare can often be perplexing, notes Jeff Collins, an esteemed Medicare specialist and Vice President of Government Programs at MVP Health Care, a prominent health insurance provider operating in New York and Vermont. Here, he sheds light on four unexpected advantages specifically provided by Original Medicare.
Telemedicine
The advent of telehealth services empowers individuals to access medical or health-related services—such as psychotherapy or speech therapy—through audio or video communication, bypassing the need for an in-person visit to a healthcare provider.
“Telemedicine services aim to enhance healthcare accessibility, available whenever and wherever individuals require it,” explains Collins.
The cost of many telehealth appointments aligns with that of in-person visits to healthcare professionals. However, the specific expenses are contingent on various factors, such as:
- Other insurance coverage a Medicare beneficiary possesses, like a Medigap policy
- The category of healthcare professionals administering care
- Fee structures of specific healthcare professionals
- Acceptance of Medicare by the healthcare provider as a form of insurance
- The nature of the facility where the beneficiary seeks care
- Location of medical services, tests, and related services availed by the beneficiary
Tobacco Cessation Support
“Tobacco usage stands as the primary preventable cause of death in the U.S.,” as per the Centers for Disease Control and Prevention. Under Medicare Part B, coverage extends to eight counseling sessions annually, aiding individuals in quitting smoking or using tobacco products. Should a beneficiary’s healthcare provider accept Medicare, these counseling sessions incur no cost for the individual.
Medical Services Outside the U.S.
Medicare typically does not extend coverage for healthcare services received outside the United States, encompassing all 50 states, Washington, D.C., Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. However, there are exceptions to this rule, as highlighted by Collins.
According to the Centers for Medicare and Medicaid Services, Medicare Part B might cover medical care abroad under specific circumstances:
- When a beneficiary resides in the U.S., the foreign hospital is closer to their residence compared to the nearest U.S. hospital, irrespective of whether it’s an emergency.
- When a beneficiary is present in the U.S. and the foreign hospital is closer than the nearest U.S. hospital capable of providing necessary medical treatment in case of a medical emergency,
- When a beneficiary is traveling via Canada from Alaska directly to another U.S. state, the Canadian hospital is closer than the nearest U.S. hospital in case of a medical emergency.
These scenarios outline instances where Medicare Part B might extend coverage for medical services obtained outside the United States.
Chronic Disease Care Services
Medicare offers coverage for certain chronic disease care services aimed at individuals dealing with at least two persistent health conditions, such as diabetes and arthritis. This coverage encompasses the expenses associated with a healthcare professional crafting and overseeing a detailed care strategy. This plan includes essential details such as diagnosis, prescribed medications, required healthcare, and the coordination of various care services among different providers.
Getting Started with Medicare Enrollment
To start your Medicare enrollment process, begin by exploring the array of plans offered in your locality. Once you’ve identified a plan that aligns with your specific requirements and financial considerations, you can proceed to apply for Medicare.
Applying is convenient and can be done through the Social Security Administration’s website or by contacting 1-800-MEDICARE (1-800-633-4227). Alternatively, you have the option to submit your application via mail.
The initial enrollment period spans from three months before your 65th birthday to three months following your birth month. This window allows you the flexibility to enroll at a time that suits your schedule and preferences.
Feel free to reach out if you need further assistance or have additional questions regarding the Medicare enrollment process.