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What’s the Biggest Surprise about Medicare?

I don’t want to give the impression that we don’t need Medicare.  We all do.  It’s not just the people who actually receive Medicare benefits that need it.  Without Medicare, entire families would fall into hardship as they struggled to cut back on food, education, housing, etc., to pay health-care bills for loved ones no longer able to work.  Still, I bet you’ll be surprised by something you don’t know about Medicare.

What’s the Most You May Pay for Health Care?

If you have a Medicare Advantage plan or Medigap Plan K or L, you can answer that question.  If you don’t, Medicare doesn’t have a maximum out-of-pocket limit.  You can’t be sure you have enough to pay for what Medicare won’t cover.

Medicare applies multiple deductibles annually.  It may cover hospital services under either Part A or Part B, which drastically changes your share of the cost.  Doctors don’t have to accept Medicare payments and can charge you extra beyond what Medicare pays them.

Does Medicare Cover Diabetes?

It pays for blood-sugar screenings and nutritional counseling.  The screenings are completely covered.  Eighty percent of the counseling is covered after you meet the annual Part B deductible.  That’s $147 this year.

Medicare also pays 80-percent of a pre-determined amount for blood sugar monitors and testing strips, lancets and lancet devices and blood sugar control solutions, once the annual deductible has been met. Sometimes, Medicare also covers therapeutic shoes.

What has surprised most of my clients is that Medicare does not cover insulin unless you use it with an external insulin pump.  Even then, you have the annual deductible and 20 percent of the cost.  Medicare Advantage plans and Part D prescription drug plans are needed to pay for oral diabetic drugs and insulin.

What If You Can’t Take Care of Yourself after a Hospital Stay?

That’s not a simple question to answer.  First, the hospital must formally admit you rather than hold you for observation before Medicare will help with nursing facility care.  And, you must have been formally admitted for at least three days not including the day you’re released.

If you meet that qualification, Medicare will pay for up to 20 days in a skilled nursing facility when you’re released from the hospital.  If you’re still not ready to care for yourself after 20 days, you can get partial coverage for longer care.  You’ll be charged $148 a day in 2013 for up to 80 more days.

That’s the extent of Medicare’s coverage until you enter the next benefit period.  Once you haven’t been hospitalized or in a skilled nursing facility for 60 consecutive days, a benefit period ends.  You have access to more Medicare coverage, but you must meet the Part A deductible again.  That’s $1,184 in 2013.

These three areas seem to surprise more of my clients that other details about Medicare, but once we start talking about specific things my clients need, there are lots of surprises.  That’s why MediGap Advisors has free consultations.  You can explore what Medicare means for your particular health care needs.

Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.

 

 
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