Medicare has a crucial role in the health of nearly 60 million Americans. Yet, many of its benefits are neglected, underutilized, or misunderstood.
Medicare offers a free annual wellness visit, during which your doctor will assess your health risks, check for cognitive impairment, take your blood pressure and other routine measurements, and provide personalized health advice. However, according to the Dartmouth Institute for Health Policy and Clinical Practice, less than 11% of Medicare beneficiaries leveraged the benefit. Moreover, recent studies show that the numbers have not changed much in the last seven years.
This isn’t the only Medicare benefit left on the table. Many healthy senior citizens pass up a host of free preventive services, from measuring bone mass to cancer screening. Other benefits, like home health care, often go unused because they have complex eligibility requirements.
If you also feel that you aren’t leveraging the Medicare benefits to their best, here are six ways to get more from Medicare.
1. Medicare Hospice Benefit
Many Medicare experts say that several Medicare beneficiaries – with the most severe health problems – unconsciously miss out on some key benefits.
If you are expected to live for six months or less, you can leverage hospice benefits. These benefits include care in your home, medication to control symptoms and relieve pain, respite care that allows family caregivers some time off, and other services.
In hospice, Medicare will not cover treatments designed to cure your terminal illness, but you can still get treatment for other conditions. Hospice doesn’t mean you give up. On the contrary, with good hospice care, a person sometimes lives longer as many of their needs are met.
2. File Appeal for Your Rights
Review your quarterly Medicare summary, which shows services or supplies taken from Medicare. If some claims are rejected, call the provider first. Often the problem is as easy as the provider entering the wrong billing code.
If the claim is submitted correctly, consider filing an appeal.
In some cases, Medicare beneficiaries have to fight for their rights. For instance, if you are in hospital and feel that you may have been discharged too early, you are entitled to ask for a quick review of your case. Then, within two days of hospitalization, you should receive a notice stating ‘an important message from Medicare about your rights,’ which includes information on appealing a discharge decision.
3. Save on Drugs
Even if you have Medicare prescription drug coverage or Part D, your out-of-pocket costs can surprise you. It’s because Part D doesn’t limit out-of-pocket costs. So, once the beneficiary reaches the threshold, they have to pay 5% of the prices of the covered drugs.
In some cases, you can limit the cost of drugs by forgetting your Part D plan and paying cash only. The reason: Big-box stores, like Costco and Target, offer a variety of generics that cost a few dollars, while many Part D plans have high standard surcharges—say $10 each time you fill a prescription. The disadvantage of cash payment is that the cost won’t count toward your deductible.
When you use your Medicare Part D plan, you’ll usually pay less if you stick to the list of “preferred” pharmacies in your plan. First, review your plan’s formulary. Most Part D plans divide their formularies into five cost-sharing tiers–preferred generic, generic, preferred brands, nonpreferred, and specialty drugs–with the lowest-tier preferred generics being the cheapest for enrollees. If you find a drug approved for your condition that’s on a lower tier than the one you are currently taking, ask your doctor if it’s appropriate for you.
4. Leverage the Medicare Freebies
Many Medicare beneficiaries don’t know about a list of things they could take advantage of and have no co-payments. These include screening for heart disease and depression, counseling to help you quit smoking, and vaccines against the flu and pneumonia.
You are also eligible for a free ™welcome to Medicare” preventive visit within the first 12 months after having Medicare Part B.
As a part of your annual wellness visit, you can redeem your free end-of-life care planning assistance, and your doctor can help you carry out advance plans adhering to your wishes. (If you schedule a proper visit to discuss end-of-life care with your doctor, you’ll pay the standard 20% co-insurance under Part B.)
If you own a Medicare Advantage plan, you can also get free wellness benefits. For example, some Advantage plans offer a SilverSneakers subscription at no extra cost. This program offers you a basic gym membership and access to group exercises designed for seniors.
5. Give Telehealth a Try
Many Medicare plans offer telehealth services, by which you can consult with the doctors and healthcare professionals electronically, much like a Skype-like consultation. Indeed, such consultations are convenient, but they can also cost less than a face-to-face visit. In addition, it can happen immediately or in a few hours.
It can even be helpful if you’re traveling and meet a health concern. However, you have to ensure, before enrolling, whether your plan supports telehealth services. You can find the service in some Medicare Advantage Plans.
6. Take Advantage of Preventive Screenings
Original Medicare offers annual wellness visits to all beneficiaries, as we discussed earlier. In addition, some preventive screenings, such as mammography and colonoscopy, are also included. These services can deal with health problems early when they are usually easier to treat. And your annual health visit is an excellent opportunity to sit down with your doctor and create a plan to help you achieve your best health next year.
If you’re willing to have more benefits, such as vision, dental checkups, etc., under your Medicare plan, then you must consider Medicare Advantage plans. Other than capping your out-of-pocket expenses, Part C plans can free you from buying Part D plans and provide additional benefits such as vision, hearing, dental programs.
If you want to know what Medicare Advantage Plan is made for you, schedule a call with our licensed agents specializing in Medicare, and they will assist you.