How Well Do You Know Medicare?

by Rhea Bautista MD, Associate Director, Hana Hou Medical Group

Guess which statements are TRUE or FALSE.

1. There are four parts of Medicare – TRUE
A. Provided by the government (Original Medicare)
Part A – Hospital Insurance which helps cover: (1) Hospital stay, (2) Skilled nursing facility, (3) Hospice care and (4) Home health care
Part B – Medical Insurance which helps cover: (1) Doctors visits, vaccines and yearly “Wellness” visits, (2) Home health care, and (3) Wheelchairs, walkers, hospital beds and other equipment

B. Provided by private insurance companies
Part C – Medicare Advantage
Part D – Prescription drug plans

2. Medicare covers everything – FALSE
Medicare Parts A and B do not cover (1) Prescription drugs (only covers basic), (2) Dental, Vision or Hearing services, (3) Fitness, (4) Dentures, (5) Long-term care, (6) Cosmetic surgery, (7) Massage therapy, (8) Routine physical exams, (9) Hearing aids and exams for fitting them, (10) Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice or direct care), and (11) Covered items or services you get from an opt-out doctor or other provider (except in the case of an emergency or urgent need)

3. Medicare Part B is Free – FALSE
You pay: (1) Premiums, (2) Deductibles, (3) Copays, and (4) Coinsurance out of pocket.

4. Medicare does not cover Prescription Drugs – TRUE
Basic Drug coverage only

5. You can enroll in Medicare whenever you want – FALSE
There are only three  times when you can enroll:

A. Initial Enrollment Period – Around the time you turn 65 years old
B. General Enrollment Period for Medicare Advantage – January 1 to March 31, 2023. Beginning January 1, 2023, when you sign up during this period, your coverage starts the first day of the month after you sign up
C. Open Enrollment Period – October 15 to December 7, 2022. You can switch to a different plan during this period. Plan will take effect January 1, 2023.

6. Medicare and Medicaid are the same thing – FALSE
Medicare and Medicaid are 2 different programs:

Medicare – health care coverage for people age 65 and over or those with a disability
Medicaid – health care coverage for people with low incomes and few resources

Some people are eligible for both

7. I can see my doctor via telehealth – TRUE
Medicare covers E-visits to allow you to talk with your doctor using an online patient portal without going to the doctor’s office.

8. There are different types of Medicare Advantage Plans – TRUE
A. Health Maintenance Organization (HMO) plan
B. HMO Point of Service (HMOPOS) plan
C. Medical Saving Account (MSA) plans
D. Preferred Provider Organization (PPO) plan
E. Private Fee-for-Service (PFFS) plan
F. Special Needs Plan (SNP)

9. There are programs to help me pay for my Medicare health care costs – TRUE
There are 4 kinds of Medicare Savings Programs:

A. Qualified Medicare Beneficiary (QMB) Programs
B. Specified Low-Income Medicare Beneficiary (SLMB) Program
C. Qualifying Individual (QI) Program
D. Qualified Disabled and Working Individuals (QDWI) Program

10. Only senior age 65 or older are eligible for Medicare Part A & B – FALSE
Qualified individuals are eligible to apply for Medicare regardless of age.

A. Age 65 or older
B. Disabled
C. End-Stage Renal Disease (ESRD)

For more information regarding your Medicare benefits please email rhea.bautista@hanahoumedicalgroup.com.