| Tue, Apr 23, 2013 @ 09:00 AM

3 Medicare Myths Set Straight

Posted by Medicare Made Clear

Medicare myths coverageOver 49 million Americans were enrolled in Medicare in 2012, according to the Kaiser Family Foundation’s StateHealthFacts.org. This number is expected to swell as baby boomers continue to “age in” to the program. Yet a 2011 National Council on Aging survey found that only 46% of older Americans and those soon to be say they have a solid understanding of how Medicare works.

Let’s look at just three common misconceptions, or myths.

Myth #1: Medicare is free.

If only it were so! Medicare is not free. You may pay premiums, deductibles, copays and coinsurance out of pocket, just like with any health insurance plan. The exact amount you pay depends on your specific Medicare coverage and how you use it. But there are some common rules.

Medicare Part B is medical insurance. It covers doctor visits, preventive care and other outpatient services. The 2013 Part B monthly premium is $104.90 for most people. It goes up from there based on your annual income. The most anyone will pay in 2013 is $335.70 a month (individuals with adjusted gross incomes above $214,000, or $428,000 for couples).

Medicare Part A is hospital insurance. It covers inpatient care and services you receive while in a hospital or skilled nursing facility. You don’t pay a monthly premium for Part A if you paid Medicare taxes for at least ten years. If you need to pay a premium, it’s $441 per month in 2013. You may pay more, depending on your income.

Both Part A and Part B charge deductibles. The Part B deductible is charged each year. It is $147 in 2013. The Part A deductible, however, is charged per benefit period. A benefit period begins the day you go into a hospital or skilled nursing facility. It ends when you have been out for 60 days in a row. You may be in the hospital more than once during one benefit period and pay just one deductible. The Part A deductible is $1,184 in 2013.

You also pay a share of the cost for your care. Under Part A, you pay a per-day copay after 60 days in the hospital or skilled nursing facility after the deductible. Under Part B, you pay 20% of the cost for doctor visits and other outpatient services after the deductible. You also pay 20% of the cost for durable medical equipment such as a walker or wheelchair. Certain preventive care services, such as an annual check-up or flu shot, are exempt from these charges.

Myth #2: Medicare covers everything.

Wouldn’t that be great? Medicare covers a lot, but not everything. Long-term care, over 100 days in a nursing home for example, is not covered. Neither is home health care, unless you meet very specific requirements. Medicare does not cover regular dental, vision or hearing care either. In addition, Medicare will not help with the cost of personal care such as help bathing, dressing, eating or using the bathroom.

It’s also important to know that most prescription drugs are not covered under Medicare Part A or Part B. If you want drug coverage, you need to buy a Medicare prescription drug plan (Part D or a Medicare Advantage plan (Part C) that includes drug coverage. These plans are offered by private companies that are approved by Medicare.

Myth #3: Medicare and Medicaid are the same.

This is just not accurate. Both Medicare and Medicaid are government programs. Both programs help people pay for health care. But that’s where the similarities end.

Medicare is generally for people who are older or disabled. Medicaid is for people with limited income and resources. Medicare is governed by the federal government. Medicaid programs are governed by the states. The federal government sets qualifying income and resource levels, but each state decides what counts when calculating this for an individual.

People who qualify for both Medicare and Medicaid are said to be “dual eligible.” If you qualify and enroll in both programs, then sometimes the two can work together to cover most of your health care costs. For information about dual eligible programs, you can call Social Security at 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. to 7 p.m. local time, Monday through Friday.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Medicare Costs at a Glance: See the 2013 costs for Medicare Parts A, B, C and D.

Medicare versus Medicaid Learn about whom each is for, what each covers and the costs.

Medicare.gov: Visit the official U.S. government site for Medicare.

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