Making Medicare Work for You

By Joshua Ferguson
Updated 2024-03-29 10:43:43 | Published 2021-02-22 06:53:08
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  • Multiple Sclerosis
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    • The Multiple Sclerosis section of the iMedix Blog is a resource rich in information about MS, covering topics like symptom management, treatment advancements, and lifestyle adaptations. It’s an essential guide for patients, caregivers, and healthcare professionals to navigate the complexities of this neurological condition.

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In 2003, after qualifying for Social Security Disability Insurance (SSDI), I began receiving Medicare. It has been a beneficial system to have, but it takes some understanding to navigate it effectively. Medicare is only available to those over 65 years old or those with a permanent disability, which is unfortunate considering the lack of universal healthcare in the United States. Qualifying for SSDI is the challenge for individuals with multiple sclerosis (MS), as previously discussed. Once qualified, it becomes important to utilize Medicare in the best way. So, what Medicare options should individuals with MS choose?

Original Medicare is a fee-for-service system where the government covers 80% of healthcare provider fees. Some providers do not accept Medicare due to the limits on what they can charge. However, there are still enough providers who accept Medicare, making it possible to find doctors who are compatible. Most people start with Medicare Parts A and B, which are provided to all SSDI beneficiaries. Part A covers hospitalization, including inpatient care, nursing facilities, hospice, and home health visits. Part B covers medical services, ambulances, durable medical equipment, mental health care, lab fees, and doctor services. Therefore, most individuals with MS require parts A and B. The premiums for Medicare Part B in 2022 start at $170/month, increasing slightly for those with incomes above $90,000/year. There is also an annual Part B deductible of $223. However, those who have paid into Social Security for 10 years or more do not have to pay premiums for Part A. The premiums for Part A vary for those who have worked fewer years.

However, parts A and B do not cover long-term care, dental care (with exceptions), vision exams for glasses, dentures, cosmetic surgery, acupuncture, hearing aids and related exams, or routine foot care. Some individuals choose to have additional coverage alongside Medicare. Medicare Part B covers 80% of outpatient medical expenses, and patients are responsible for the remaining 20%. Since I try to minimize my doctor visits, I am able to manage these costs. Although I have never required hospitalization while on original Medicare, having the coverage gives me peace of mind.

Medicare Part D covers prescription drugs, which is crucial for people with MS. Part D has monthly premiums, copays for most drugs, and typically a deductible. It may not be necessary for individuals who do not take prescription drugs, but the longer they wait to start it, the higher their premiums will be. Part D covers most disease-modifying drugs for MS but does not cover experimental drugs. It is important to clarify drug coverage with doctors or pharmacists before prescriptions are written.

When I first received Medicare, I transitioned from being a Kaiser nurse and patient for 12 years to seeing a doctor who accepted Medicare patients. I originally chose straight original Medicare with parts A and B. However, as time passed, I required more medical care, particularly after losing bladder function. This led to me needing urologists, supplies, urinary infection treatments, and therapy. As a result, I enrolled in Kaiser's Medicare Advantage plan under Medicare Part C.

Medicare Part C, commonly known as Medicare Advantage, covers services provided by parts A and B, as well as additional services not covered by these parts. They usually have their own premiums and copays, but they are less than the 20% required by Medicare Part B. Most Medicare Advantage plans include Part D prescription drug coverage. Some plans offer extra coverage for dental, vision, and fitness memberships, but I do not require those. Although Advantage plans charge premiums, in some cases, the premium may be the same as or similar to the cost of straight Medicare parts A and B. I pay an additional $90/month for my plan, but I believe it is well worth it.

There are different types of Medicare Advantage plans, and individuals with varying needs may find different plans more suitable. Those with needs exceeding what Medicare covers may consider supplemental or Medigap insurance to cover costs not included in original Medicare, such as deductibles, copayments, and coinsurance. Those with very low incomes may be eligible for Medicaid, which, when combined with Medicare, provides extensive coverage. I am grateful to have Medicare, and my HMO plan works well for me. I could have stayed with straight Medicare and avoided involving insurance companies, but I appreciate having a place to go for help without facing financial difficulties. I hope that everyone can have such comprehensive coverage in the future.

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