Medicare: 4 Things You Might Not Know

Medicare provides comprehensive health insurance coverage primarily for individuals aged 65 and older. Its benefits encompass medical services, including hospital care, physician services, prescription drugs, preventive services, and more.

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Medicare: 4 Things You Might Not Know
8 Min Read May 27th, 2023

Did you know you could get help quitting smoking through Medicare-covered counseling sessions? If you are 65 and older, you probably know Medicare; if you are younger, you probably have heard of the program.

Medicare is a federal health insurance program for people 65 and over, people with certain disabilities, and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant). Medicare has four parts:

  • Part A covers inpatient hospital stays, skilled nursing facility stays, hospice care, and some limited home health care services following surgery.
  • Part B covers doctor visits, outpatient hospital services, and some preventive services.
  • Part C (Medicare Advantage) is a private health insurance plan that combines all or some of the benefits of Parts A and B.
  • Part D covers prescription drugs.

Medicare supplements, also known as Medigap, are private health insurance plans that can help pay for some of the costs that Medicare doesn't cover, such as copayments, deductibles, and some out-of-pocket costs.

Medicare Advantage plans are private health insurance plans that are approved by Medicare. These plans offer all or some of the benefits of Medicare Parts A and B, and they may also include prescription drug coverage. Medicare Advantage plans often have different rules and costs than Original Medicare.

Medicare has been around for a long time, but its coverage changes regularly, and there are many services that many people on Medicare don't know. Below, we'll discuss some things you might not know about Medicare, from covering transportation to offering nutritional therapy services.

Covers Medical Transportation

Medicare plans typically do not cover transportation to and from doctor visits. However, there are some instances where patients can receive free long-distance non-emergency medical transportation. To qualify for this benefit, the transportation must be deemed medically necessary by a doctor or licensed medical professional. Additionally, the transportation must be provided by a Medicare health care provider partner.

If someone's situation meets both of these criteria, they may be eligible for free transportation to a medical treatment facility. For example, if you have kidney failure, Medicare may cover transportation to dialysis treatment if approved by your doctor.

Offers Services to Help Smokers Quit

Tobacco addiction is a significant health problem for millions of Americans, especially seniors who may have years or decades of addiction to overcome. Quitting tobacco is tremendously difficult for many, but Medicare plans cover services to help those who need help quitting.

Medicare plans can cover up to eight visits per year with a doctor or health care provider to help you deal with tobacco addiction. If you are finally looking to quit smoking or want to help someone else quit smoking, remind them that Medicare can help them finally kick the habit.

Here are some of the services that Medicare covers to help you quit smoking:

  • Counseling: Medicare covers counseling from a doctor or other qualified health care provider. This counseling can help someone understand the risks of smoking and develop a plan to quit.
  • Medications: Medicare covers some medications that can help someone quit smoking. These medications can help reduce cravings and withdrawal symptoms.
  • Support groups: Medicare covers support groups for people trying to quit smoking. These groups can provide encouragement and support from other people going through the same thing.

Talk to your doctor about Medicare's coverage for smoking cessation services for those interested in quitting smoking. Your doctor can help you develop a plan to quit and refer you to the needed resources.

Offers Nutritional Therapy Services

Did you know that Medicare can help you curb harmful eating habits? If you have a qualifying nutritional condition, such as diabetes or kidney disease, you may be eligible for nutritional therapy services. Nutrition is important to overall health, especially for those with nutritional conditions.

Medicare plans cover a variety of nutritional therapy services, including:

  • Lifestyle and nutritional assessment: A registered dietitian (RD) will assess eating habits and lifestyle to develop a personalized plan to improve nutrition.
  • Nutritional therapy: The RD will provide education and counseling on making healthy food choices and improving overall nutrition.
  • Follow-up visits: The RD will follow up with you to track progress and make adjustments to the plan as needed.

For those with diabetes or other nutritional-related ailments, talk to your doctor about nutritional therapy under your Medicare plan. Nutritional therapy can help you improve your nutrition and manage your condition, leading to better overall health.

Covers Alcohol Treatment and Counseling

Alcohol addiction and misuse is another significant health concern that many Medicare seniors struggle with. Even those that don't meet the criteria of alcohol dependency can still get help from Medicare-covered services to curb their drinking patterns and lifestyle.

Medicare plans help those with significant alcohol addiction with services like psychotherapy, prescription drugs, and a structured assessment and brief intervention. If a doctor determines someone misuses alcohol, they can still qualify for four Medicare-covered counseling sessions to address alcohol issues.

Many Other Benefits

Here are some other unusual or relatively unknown Medicare benefits:

  • Medicare Part D Extra Help: This program helps people with limited income and resources pay for their Medicare Part D prescription drug coverage.
  • Medicare Savings Programs: These programs help people with limited income and resources pay for their Medicare Part A and/or Part B premiums, deductibles, and coinsurance.
  • Medicare Advantage Prescription Drug Plans: These plans combine Medicare Part A and Part B coverage with prescription drug coverage. They may offer additional benefits like vision, dental, and hearing coverage.
  • Medicare Advantage Special Needs Plans: These plans are designed for people with specific health needs, such as chronic conditions or disabilities. They may offer additional benefits, such as case management and transportation assistance.
  • Medicare-Medicaid Plan (MMP) Coordination: This program helps people eligible for both Medicare and Medicaid get the most out of both programs.
  • Medicare-Medicaid Cost-Sharing Reduction (CSR) Program: This program helps people eligible for both Medicare and Medicaid pay for their Medicare Part D prescription drug coverage.
  • Medicare-Medicaid Buy-In Program: This program helps people eligible for both Medicare and Medicaid but with too much income to qualify for full Medicaid benefits get partial Medicaid benefits.
  • Medicare Part B Home Infusion Therapy: This benefit covers the cost of home infusion therapy for certain conditions, such as cancer, kidney disease, and HIV/AIDS.
  • Medicare Part B Blood Glucose Monitoring Supplies: This benefit covers the cost of blood glucose monitoring supplies for people with diabetes.
  • Medicare Part B Durable Medical Equipment (DME): This benefit covers the cost of certain DME, such as wheelchairs, walkers, and oxygen tanks.
  • Medicare Part B Outpatient Mental Health Services: This benefit covers the cost of outpatient mental health services, such as counseling and therapy.
  • Medicare Part B Preventive Services: This benefit covers the cost of certain preventive services, such as flu shots and mammograms.
  • Medicare Part B Telehealth Services: This benefit covers the cost of certain telehealth services, such as video visits with your doctor.

Long-Term Care and Medicare

Medicare only pays for a limited amount of skilled care. Skilled care is care that requires the skills of a licensed health care professional, such as a registered nurse or physical therapist. Medicare will pay for skilled care if you need it to recover from a medical condition or to prevent a decline in your health (generally for no more than 100 days -- 20 days from Medicare and 80 days from a supplement.)

Medicare does not pay for custodial care. Custodial care is care that helps an individual with daily living activities like bathing, dressing, eating, toileting, and related hygiene, etc.

This can be a problem for many people who need long-term care, as most people who need care need custodial care, not skilled care. There are a few options for people who need custodial care and do not have private insurance to pay for it. One option is to use Medicaid, a joint federal and state health insurance program for low-income individuals and families. Another option is to pay for care out of pocket.

Other Options for Long-Term Care

If you are considering using Medicaid to pay for custodial care, you should be aware that there are eligibility requirements. You must meet certain income and asset limits to qualify for Medicaid. You can find more information about Medicaid eligibility requirements on the Medicaid website.

If you are paying for care out of pocket, you should be aware that the cost of long-term custodial care can be high. You may want to consider Long-Term Care Insurance, which can help pay for all types of long-term health care, including custodial care. 

LTC Insurance is not Medicare or traditional health insurance. It is usually purchased when someone is in their 40s or 50s as part of retirement planning. 

How Does Long-Term Care Insurance Differ From Other Types Of Insurance?

There are several types of Long-Term Care Insurance, including traditional and asset-based hybrid policies that include death benefits. Traditional health insurance, including Medicare, will always have the first right of payment. However, because health insurance and Medicare only pay for a limited amount of skilled care, LTC insurance will pay for the rest if you meet the benefit triggers.

Here are some of the benefits of LTC insurance:

  • It can help pay for the cost of long-term health care, such as in-home care, adult day care centers, assisted living, memory care, and nursing home facilities.
  • It can help you stay in your home longer when you need help with activities of daily living.
  • Knowing that you have financial protection when you need long-term care can give you peace of mind.

What Are The Components Of A Long-Term Care Insurance Policy?

Understanding how Medicare will work is vital for retirement planning. Knowing how Medicare works also helps you assist older parents who may need the many benefits of Medicare.

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About the Author

Mallory Knee is a freelance writer for multiple online publications where she can showcase her affinity for all things beauty and fashion. She particularly enjoys writing for communities of passionate women who come together for a shared interest and empower one another in the process. In her free time, you can find Mallory trying a fun new dinner recipe, practicing calligraphy, or hanging out with her family.

LTC News Contributor Mallory Knee

Mallory Knee

Contributor since September 25th, 2020

Editor's Note

Traditional health insurance plans, including Medicare and supplements, play an indispensable role in providing financial coverage for many medical services. However, it's important to note that these plans don't cover most long-term care services, creating a significant gap that will impact you and your family financially and often placing a considerable burden on loved ones. 

People need long-term health care services due to frailty from aging, chronic illnesses, accidents, mobility problems, and dementia. 

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Premiums vary dramatically between insurance companies, so be sure to find a specialist who can shop all the top-rated insurance companies. 

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