Many seniors are unsure exactly how Medicare works, so we’ve assembled this information to give a quick rundown on everything you need to know. If you are preparing to sign up for this federal health insurance program but aren’t sure where to start, these Medicare FAQs are for you.
Basic Medicare FAQs
Who is Eligible? Those aged 65 and older are the most commonly eligible recipients of Medicare, although it may provide coverage for certain younger individuals with disabilities.
When Should You Enroll? Individuals should enroll in Medicare immediately upon their 65th birthday. If that date is missed and late enrollment is necessary, there are typically monetary penalties. You can avoid these penalties by working past your 65th birthday and maintaining health insurance through your employer.
How Do You Sign Up? Individuals should fill out an application to enroll in Medicare on the United States Social Security Administration’s website. Click here to visit the Social Security Administration’s website.
How Does the Program Work? Medicare has specific “parts” that cover various healthcare services and can be built to create a personal program that protects your medical situation and anticipated needs. There are two primary programs – Original Medicare and Medicare Advantage. When enrolling in the program, consult your healthcare provider regarding the best options for you.
Medicare Coverages Explained
Part A (Hospital Insurance): Medicare Part A generally covers inpatient hospital care, as well as stays in nursing facilities, hospice care, inpatient and acute care rehabilitation, and home health care.
Part B (Medical Insurance): Medicare Part B provides coverage for necessary services or supplies used for diagnosing or treating medical issues. It may also cover some healthcare expenses, including preventative screenings, vaccinations, and annual checkups; outpatient or home health care; mental health services; prescription drugs; and durable medical equipment like walkers, wheelchairs, and hospital beds.
Part A and Part B do NOT provide coverage for:
- Long-Term or Custodial Care
- Dental Services
- Eye exams for Vision Prescriptions
- Dentures or Hearing Aids
- Acupuncture
- Routine podiatry
- Cosmetic surgery
Part D (Prescription Drug Coverage): Some prescription drugs are covered under Medicare Part A, but Medicare Part D can assist with those costs. This may help you to reduce your drug costs and avoid higher costs in the future. All Medicare coverage plans cover a broad spectrum of prescription drugs. To learn about Medicare Part D drug plans, click here.
Additional Medicare Resources
United States Medicare Website: Medicare.gov
United States Medicare Phone Number: 1-800-633-4227
United States Social Security Administration: https://www.ssa.gov/
United States Social Security Administration Phone Number: 1-800-772-1213
Does Medicare Cover Assisted Living Costs?
Medicare doesn’t typically apply to long-term care like assisted living. It only covers long-term care if skilled nursing services are required for wound care or occupational or physical therapy following a hospital admission. These types of stays are generally only covered for up to 100 days.
Assisted living facilities differ from skilled nursing facilities because residents are often more independent than those in a nursing home. While they live independently, they benefit from 24-hour supervision and help with ADLs, known as custodial care. Medicare doesn’t cover custodial care. However, it may cover the following for assisted living residents:
- some preventive medical or health-related services
- prescription medications
- wellness or fitness programs
- transportation to and from medical appointments
A Banyan Residence is an assisted living facility located in The Villages. If you or a loved one needs a quality adult residence but have questions regarding financing or Medicare, set up a visit today.
