Debunking Medicare in 2019
About 10,000 Americans reach age 65 and become eligible for Medicare each day. If this milestone is coming up for you, you may have heard a lot of things about Medicare. Some of them are true, and some are myths, promoted by the media or well-meaning friends who don’t really have their facts straight.
One of our missions at MedicareFAQ is to provide you with up-to-date, accurate answers to your Medicare questions. Here are 6 common misconceptions about Medicare in 2019.
6 Common Misconceptions About Medicare
Medicare is Going Broke
Each year, the government releases a report on the financial health of Medicare and Social Security. The most recent report projected that Medicare’s Hospital Reserve Fund would be depleted by 2026. But that doesn’t mean Medicare will be flat broke. It still has income, including the premiums paid by beneficiaries.
If the reserve fund is depleted, doctors and hospitals would not receive full compensation for their services from Medicare. Patients might have to share more of the cost. Or, Congress could make changes to Medicare’s funding to make up for the shortfall.
The Age for Medicare Eligibility Is Going Up
Ever since Medicare was established in 1965, it has been available to Americans aged 65 and up. And there are no plans to change that.
But the eligibility age for the other big retirement benefit plan—Social Security—is changing, and that has confused some people. You can start collecting Social Security at age 62, but your monthly benefit will be lower if you start getting Social Security before you reach your “full retirement age.”
Full retirement age used to be 65—the same age as eligibility for Medicare. But the full retirement age for Social Security has been slowly going up. The full retirement age will be 67 for people born in 1960 and later.
Pre-Existing Conditions Don’t Matter for Medicare
One feature of the Affordable Care Act is that individuals can get insurance policies regardless of any health conditions they have. The same thing is true of Original Medicare and Medicare Advantage plans. Pre-existing conditions are never a factor.
But pre-existing conditions can be an issue if you delay signing up for a Medicare Supplement, or Medigap, plan.
This means the insurance company must issue you a policy, and it can’t charge you more if you have medical conditions. But if you wait to enroll in a Medigap plan, or if you change plans, your application will go through the medical underwriting process. That means the insurance company will use information about your health to decide whether to cover you and how high your premium should be.
Medicare Will Cover Assisted Living
Medicare is designed to cover medical expenses, not the custodial care you receive at an assisted living facility. That means Medicare will not cover your rent, meals, or the cost of having someone assist you with daily tasks. However, if you receive physical therapy or are treated by a doctor or nurse at your assisted living facility, Medicare might cover the cost of those services.
Many people plan for assisted living by purchasing a long-term care insurance policy. Some assisted living may be covered by Medicaid, a state-run program for people with low incomes who have exhausted all their assets. Otherwise, it will be up to you and your family to pay for assisted living expenses.
Medicare Pays for Hearing Aids
Although it seems logical that Medicare would cover hearing aids, that’s not the case. Medicare also doesn’t cover routine hearing exams, routine dental and eye care, dentures, or eyeglasses.
There are, however, supplemental Medicare policies available to cover these specific needs. In addition, some Medicare Advantage plans include hearing, dental and vision coverage as part of a package.
The Donut Hole Means I’ll Have to Pay the Full Cost of My Prescriptions
The “donut hole” is a strange quirk of Medicare Part D prescription coverage. When your prescription costs reach a certain amount—$3,820 in 2019—you enter the “donut hole” and are responsible for paying a greater share of the cost of your prescriptions until you reach a second threshold and catastrophic coverage kicks in. At that point, you pay no more than five percent of the cost of your medications.
Back in 2006, you were responsible for 100 percent of your prescription costs while you were in the donut hole. But since the passage of the Affordable Care Act, Congress has been closing the hole.
In 2019, being in the donut hole means you’ll pay 25 percent of your brand-name prescription costs, and 37 percent of your generic medication costs. Catastrophic coverage kicks in once you have spent $5100 out of your own pocket.
With all the terminology, dates and acronyms, Medicare coverage can be confusing. Our goal at MedicareFAQ is to demystify Medicare, through online articles and trained, informed agents who can answer your questions and match you with the best coverage for your needs.
Below are a few articles we have to help you prepare for AEP this year: