Nearly all elderly Americans are subscribed to any form of Medicare coverage and are generally pleased with its provisions. However, a vast majority of Medicare subscribers are unaware of the many numerous allowances your Medicare insurance covers. Here is a list of the six biggest Medicare secrets and hacks that may allow you to get the most of out of your Medicare policy.
1. Medicare Covers Weight Loss Surgery
In 2006, Medicare and Medicaid included provisions for weight loss, technically known as bariatric, surgery for its subscribers. However, policy holders must meet some stringent requirements to considered eligible for the procedure. First off, applicants must have a body-mass index (BMI) of at least 35 – categorized as Obese Class II or being severely obese. In addition to being “severely obese”, eligibility for bariatric surgery also requires a condition that exacerbates the obesity which would include osteoarthritis, coronary artery disease and hypertension. The procedure must also be done by a Medicare-approved surgeon.
2. You’re Entitled To Free Preventative Care
Preventative care is something that keeps Medicare program costs down and subscribers are urged to take advantage of the free check ups and procedures that can keep you healthy in the long-term. The best part of this provision is that coverage is provided without a deductible. Under the Affordable Healthcare Act, subscribers are entitled to a free wellness check. Other free annual provisions include mammograms and flu shots. Beneficiaries can also capitalize on the free cardiovascular screenings every five years. Other benefits include free colonoscopies, cervical and prostate screenings and bone mass measurements.
3. You Can Overturn Coverage Denials
What many Medicare subscribers don’t realize with the program is that they have the right to appeal any coverage or payment decision made by Medicare. Based on how the appeals process is structured, you have essentially five tries to have your appeal approved. If you think that the a denial in coverage would seriously affect your health in the near-term you can have the appeal expedited within 72-hours.
4. The Unadvertised Out of Pocket Costs
Medicare is rather comprehensive in its coverage but for many, it unfortunately leaves them hanging out to dry when it comes to essential medical provisions. For example, Medicare does not include dental or eye care. In these cases, subscribers are required to purchase eye and dental plans from a third party provider. The same goes for policy holders looking to use their plan to get prescription eye glasses, dentures or hearing aids. Additionally, those looking for subsidized costs for nursing homes or assisted living facilities are out of luck as Medicare requires those costs to be funded 100% out of pocket.
5. You’ve Got No Choice But To Participate
Medicare is an entirely compulsory program, meaning once you turn 65, you HAVE to play nice and subscribe to Medicare. In fact, those who try to deny Medicare coverage face stiff penalties. The worst of these penalties include not being able to collect Social Security benefits. However if anyone over 65 initially refuses Medicare and at a later time signs up for either Plan A, B, or D, they would have to pay a penalty premium that is 10 percent higher for EACH year they were not enrolled for the rest of their lives.
6. Funding For Medicare Is Running Out
Unfortunately, funding of Federal Medicare Insurance Trust Fund is drying up. In fact, since 2008 the program has proved itself insolvent – using more money for the program than it is being funded. In fact it is projected that the program is going to be broke by 2024. But do not fear, a fix is in the works and would include a mix of increasing payroll tax by almost 100% with reducing program expenditures by over 25%. Only time will tell the fate of this much needed federal program.
Medicare is not a simple program. Learn more about the ins and outs of Medicare, talk with an expert. Contact the Law Office of Christina Lesher to help through Medicaid and Medicare planning. Call (713) 529-5900.