As you approach and enroll in Medicare, it's important to have a good understanding of just what it does and doesn't cover -- lest you go without something that would be of great use to you. Medicare is there to help more than 50 million Americans pay for healthcare, so be sure you're making the most of it.
Below are three benefits that many people don't even know that Medicare offers.
Selena Maranjian: You probably know that Medicare isn't free. It's supported via payroll taxes taken out of paychecks and once its members enroll, usually at age 65, they face payments, too: premiums, deductibles, copays, and/or coinsurance payments (where the member pays 20% of the cost of a service or product, with the program picking up the other 80%). Despite all that, though, there are plenty of services that you won't have to make out-of-pocket payments for as a Medicare enrollee -- such as a host of screenings for various diseases.
Here are some specific examples of screenings you can (and often should) get for free:
- Abdominal aortic aneurysm
- Alcohol misuse
- Breast cancer
- Cardiovascular disease
- Cervical & vaginal cancer
- Colorectal cancer
- Hepatitis C
- Lung cancer
- Prostate cancer
- Sexually transmitted infections
The screenings come in a wide variety of forms, such as via blood work, colonoscopy, mammogram, bone density test, questioning, and more. You can get some regularly (such as annual mammogram screenings and annual depression screenings) and others are more restricted. To screen for abdominal aortic aneurysm, for example, Medicare will pay for a one-time ultrasound if your doctor refers you for one. Diabetes screenings are free if you have one or more risk factors, such as obesity or high blood pressure. Men aged 50 and older can receive free PSA tests and digital rectal exams to screen for prostate cancer.
The overall cost of healthcare is steep these days and you may wish that Medicare coverage was more generous than it is. Still, take comfort in the fact that the program offers a lot of free screening that can help identify serious conditions early so that they can start being treated.
Brian Feroldi: Obesity levels in the U.S. are, unfortunately, astronomically high, with roughly one out of every three Medicare enrollees believed to be obese. That's a major problem as obesity can greatly increase a person's risk of developing heart disease, type 2 diabetes, and even certain types of cancer.
Thankfully, Medicare has a program in place that can help anyone who is obese and wants to learn how to lose weight. Medicare will cover the cost of behavioral counseling sessions as long as the patient has a body mass index of 30 or higher.
During the sessions, the patient will meet with a provider in a primary care setting (such as a doctor's office) and they will receive a personalized plan designed to help them shed their extra weight. Treatment options will include basic counseling on topics such as diet and exercise. If the provider feels it's necessary, sometimes weight-loss drugs will be recommended.
Medicare is willing to cover the cost of these sessions for up to one year if you qualify, so if you're interested in learning more, find out if your doctor is a participating provider.
Dan Caplinger: One area in which there's a lot of confusion is the coverage that Medicare provides for chiropractic services. The misinformation on chiropractic care among patients and medical professionals alike is so prevalent that Medicare has put out a fact sheet (link opens PDF) to counter it.
For instance, some people mistakenly believe that there's a 12-visit limit on chiropractic services, when in reality, there are no caps as long as the care is covered and is given by appropriately licensed chiropractic professionals. On the provider side, many chiropractors erroneously think that they can opt out of Medicare entirely, and they get confused about what types of services qualify for reimbursement from the program. For example, spinal manipulation services are considered active care if they're made for an acute or chronic condition, and so they can be reimbursable under some circumstances. Maintenance therapy, on the other hand, isn't medically reasonable or necessary and therefore doesn't qualify. Finally, Medicare doesn't allow chiropractic medical professionals to order durable medical equipment for direct reimbursement, although a chiropractor can act as a supplier if qualified.
Knowing that chiropractic care is an area where people get confused is important if you intend to get medical services. That way, you'll know in advance to get clarification about whether the service you need will get reimbursed.
Learn more about Medicare and you may be pleasantly surprised by what else is covered.