If you have Medicare or will soon have it, you probably know what it covers on a basic level. But do you know about the less common perks that come with Medicare coverage? These perks aren’t technically free, since Medicare itself isn’t free. However, many Medicare recipients don’t have to pay anything out of their own pocket for these benefits.
There are a few exceptions. For example, there may be limits on how often you can see a doctor, and your doctor must agree to Medicare’s billing rules. Still, it’s good to know that you can get these benefits if you have Original Medicare or Medicare Advantage.Medicare advantage plans come with their own set of benefits in addition to the services that Original Medicare requires. Below are the “free” services that Medicare beneficiaries can access. They all help you save money and stay in good health.
Part A Premiums
Part A mainly covers hospital stays and inpatient care. While Part B mainly covers services in outpatient centers and doctor’s offices. Most people don’t have to pay a monthly fee for Part A coverage as long as they or their spouse paid Medicare taxes when they worked. Usually, you need to work and pay Medicare taxes for at least 10 years to avoid paying a premium for Part A.
Welcome to Medicare Visit
After you sign up for Medicare Part B, which pays for doctor visits and other outpatient services, you can get one free “Welcome to Medicare” checkup at any time during the first 12 months. This checkup is not a full physical test, but it gives your doctor a chance to look at your health and make a plan for your future care. You don’t have to get the “Welcome to Medicare” checkup, but if you do, it will help your doctor create a baseline to keep track of your health with your future annual wellness visits. However, Medicare will not pay for a wellness visit in your first year of Part B.
Annual Wellness Visits
Medicare beneficiaries are also able to get a free wellness visit once a year. This visit is meant to help you update your personalized health plan depending on how your health has changed year to year. It helps your doctor find new symptoms or possible health concerns early. The visit includes:
Reviewing your medical history as well as family medical history
Updating or changing your prescriptions
Recording your height, weight, and blood pressure
Checking your cognitive impairment
Creating a care plan based on any findings
It’s important to note that while the visit itself is free, if you get any additional testing or treatments that aren’t considered covered preventative care there may be a copay.
Vaccines
Medicare Part B covers a number of vaccines for free without any copayments. Starting in 2011 the Affordable Care Act got rid of cost sharing for many types of tests and vaccines that help people stay healthy. Here are the shots that Part B pays for. Depending on your age, risk, and when you get the vaccine or series of vaccines, you may have to meet certain requirements:
COVID-19 – Even though the public health emergency stopped on May 11, 2023, Medicare still pays for COVID-19 vaccines. Providers who are part of Medicare can’t charge Medicare recipients for the shot.
Flu – Most people of all ages get flu shots every year during flu season, which usually lasts from October to May, with most people getting sick from December to February. For extra protection, the Centers for Disease Control and Prevention (CDC) advises that people 65 and older get the high-dose version.
Hepatitis B – Part B covers the hepatitis B vaccine as a preventive benefit for people with diabetes, end-stage kidney disease, or hemophilia, who are at medium or high risk for getting the virus.
Pneumonia – Medicare pays for the pneumonia vaccine, which can help protect you from pneumococcal disease, which can lead to pneumonia, meningitis, and other illnesses. Medicare pays either a single dose of the vaccine or a two-dose series, with the second dose needed at least a year later for most people 65 and older. People who don’t have strong immune systems may get the second dose sooner.
Cancer Screenings
Medicare pays for several cancer screenings. Although some have requirements or are only covered in certain time frames.
Breast Cancer
Medicare Part B covers one mammogram test every 12 months for all women 40 and over. If you are between 35 and 39 years old and are eligible for Medicare, you get one free baseline mammogram. If your doctor accepts Medicare assignment the mammograms are free. Accepting assignment means that your doctor agrees to accept the Medicare-approved amount for the test as full payment rather than charging more.
Colorectal Cancer
Medicare will cover several screenings for colorectal cancer with specific guidelines for each;
Colonoscopy – If you have Medicare and are at high risk for colorectal cancer, you can get a screening colonoscopy every two years. If you don’t have a high chance of getting colon cancer, the test is covered once every 10 years, or 120 months. There is no minimum age, and if your doctor agrees, these tests won’t cost you anything.
Fecal occult blood tests – If you are 50 or older and have Medicare, you may be able to get one fecal occult blood test every 12 months to check for colon cancer. If your doctor agrees to do the tests, you won’t have to pay for them.
Stool DNA labs – Medicare will pay for a multi-target stool DNA lab test once every 3 years if you are 50 to 85 years old. You must meet certain requirements, such as having a normal chance of getting colorectal cancer and not having any signs of colorectal disease. If your doctor agrees to do the tests, you won’t have to pay for them.
Cervical Cancer
Part B of Medicare pays for a Pap test and pelvic exam every 24 months if you have Medicare. As part of the pelvic exam, the breasts are looked at to see if there are any signs of breast cancer. You might be able to get a screening test once a year if:
You have a high risk for vaginal or cervical cancer
You’re at childbearing age and had an abnormal pap in the last 36 months
If you are between the ages of 30 and 65, your Pap test every 5 years also includes an HPV test. If your doctor agrees to do the tests, you won’t have to pay for them.
Prostate Cancer
Medicare Part B pays for blood tests for prostate-specific antigen (PSA) and digital rectal exams (DRE) once a year for people 50 and older. The yearly PSA tests are free and won’t cost you anything if your doctor agrees to do them. The Part B deductible applies to the DRE, and Medicare will pay 80% of the allowed amount.
Medicare Part B will pay for a low-dose computed tomography (LDCT) lung cancer test once a year if you are between 55 and 77 years old. If your doctor accepts Medicare assignment, the tests will cost nothing. You do have to meet certain requirements such as:
You have no lung cancer symptoms
You smoke, or quit within the last 15 years
Your smoking history had an average of a pack a day
Medicare Part B pays for a yearly screening for depression. To be screened for depression, you don’t have to show any signs or symptoms, but the screening has to happen in a place where people get basic care, like a doctor’s office. This means that Medicare won’t pay for your screening if it happens in a hospital, skilled nursing facility (SNF), or emergency room. The annual depression check is done with the help of a questionnaire that you or your doctor fills out. This quiz is meant to show if you are at risk for depression or have signs of it. If your test results show that you might be at risk for depression, your provider will do a full evaluation and, if necessary, refer you for more mental health care.
Most of the time, you should get a depression test when you already have an appointment with your doctor. But your provider can choose to do the screening on a different visit. Original Medicare pays 100% of the Medicare-approved amount for depression screenings when they are done by a qualified provider. This means you don’t have to pay anything (no deductible or share). Medicare Advantage Plans are required to cover depression screenings without deductibles, copayments, or coinsurance if you see a provider in their network and meet Medicare’s standards for the service.
Diabetes Screenings
When diabetes is treated early, it can help people avoid problems. Depending on how likely you are to get diabetes, Medicare will pay for up to two diabetes tests per year. Medicare will also help you learn how to take care of your diabetes, but you’ll have to pay for it. Medicare also has a program to help people who are at risk of getting diabetes, but haven’t been officially diagnosed. This program is free of charge.
Working With EZ
Using the free services Medicare gives is a good way to stay as healthy as possible. If you’re new to Medicare, you should learn how it works so you can take advantage of all the services it offers. EZ can help you sign up for Medicare, buy a Medicare Supplement Plan, or just figure out what your best choices are. Our insurance brokers work with the best firms in the country. You can get a free review of all the plans in your area from them. We’ll talk about your physical and financial needs and help you choose a plan that fits them. To get started, just call 877-670-3602 and talk to one of our certified agents.
Medicare is the nation’s health insurance program for seniors 65 and older. It also provides coverage for younger people who meet specific eligibility criteria. Medicare Parts A, B, C, and D cover a large variety of your major medical expenses. It’s a great program but it can be difficult to read through all of the plans, options, and rules. This can make it difficult to choose the right plan on time. Below we’ve outlined some of the most common Medicare mistakes so you know what to avoid and not wind up with penalties, coverage delays or gaps.
Signing Up Late
Medicare has specific deadlines to enroll. Your Initial Enrollment Period (IEP) happens when you first become eligible for Medicare. It starts 3 months before your 65th birthday, including your birth month, and then ends 3 months after you turn 65. This gives you 7 months to enroll. If you’re receiving Social Security benefits then you will be automatically enrolled and you don’t have to do anything or worry about the deadlines, Social Security handles enrollment for you. However, if you are not automatically enrolled you have to apply yourself during your IEP. If you miss the IEP you do have another opportunity between January 1st and March 31st called the General Enrollment Period (GEP).
Missing these enrollment periods is one of the most common and costly mistakes people make. If you miss both enrollment periods you can face late enrollment penalties for Medicare Parts A, B, and D. It’s important to note that there is a way to avoid these penalties. If you qualify for a Special Enrollment Period (SEP) then you will be able to enroll in Medicare penalty free with all the same benefits as when others enroll during the IEP.
SEP Types
Qualifying life event – If you have a qualifying life event then you qualify for a 2-month SEP where you have 2 months to enroll in Medicare. The most common qualifying events are:
You moved out of your current plan’s service area
Your plan no longer serves the area you are in
If you decide to switch from Medicare Advantage to Original Medicare within 12 months of enrolling in the Medicare Advantage plan.
You move into or out of a facility such as a nursing home
If you’ve lost Medicaid eligibility
Working past 65 – If you decide to continue working past 65 and have creditable coverage through your or your spouse’s employer’s health plan then once you leave your job you will open an 8-month SEP. This SEP does have a stipulation, if you want Part D you have to enroll in it within the first 2 months of your 8 month SEP, otherwise you still face penalties. Your 8 months begin the day you no longer have credible health coverage.
Medicare Part A Penalty
Some people qualify for Part A premium-free. If you’ve worked and paid into Social Security and Medicare taxes for at least 40 calendar quarters, then you are eligible for Railroad Retirement benefits (RRB), or have a spouse that qualifies for premium-free Part A then you will get Part A for free. However, if you don’t and have to pay for Part A, then you can face a 10% increase on your premium for missing the IEP. This penalty stays with you for twice the number of years that you were eligible and didn’t sign up. For instance, if you were eligible for Part A for 3 years and did not enroll, you’ll have the penalty for 6 years.
Medicare Part B Penalty
If you miss your enrollment period and don’t qualify for an SEP, you will face a Part B penalty. This penalty is a 10% increase for every year you did not sign up. For example, say you waited 2 years to enroll. You’re looking at a 20% increase in your premium, 10% for each of the 2 years you delayed. The standard Part B premium for 2023 is $164.90, plus adding the 20% will bring your premium up to $197.88 which will be rounded up to the nearest $.10, making it $197.90 for part B. That’s $32.98 extra every month that you could have saved by enrolling on time. Now that might not seem like a lot, but if you look at it on a yearly basis that is $395.76 a year!
Medicare Part D Penalty
The amount of the penalty depends on the length of time that you did not have Part D or a creditable prescription drug plan. Medicare determines the penalty amount by multiplying 1% of the national base beneficiary premium ($32.74 in 2023) by the number of full months you went without drug coverage. The penalty amount is then rounded to the nearest $.10 and added to your monthly premium. The national base beneficiary premium can vary from year to year, so your penalty will change with it.
For example, say you waited 14 months to enroll in Part D and didn’t have creditable drug coverage for any of that time. You’ll have to pay a 14% penalty. For 2023 that would be $4.58 rounded up is $4.60 extra on your premium.
Assuming Spouse Coverage
Assuming your spouse is covered by Medicare because you have it or vice versa is a big mistake. It could leave you or your spouse without insurance. Medicare doesn’t work the same as an employer group plan. Meaning it won’t cover your family, it only applies to the individual who enrolls. If you worked and paid your Medicare taxes for the last ten years then at most your spouse who is 65 will be eligible for premium-free Part A. If your spouse is under 65, they need to find their own coverage elsewhere, such as a plan from the Health Insurance Marketplace, their own group plan, or COBRA. Additionally, if your spouse is under 65 they still may be eligible under certain conditions. Medicare is available to anyone who receives Social Security Benefits for at least 24 months, has End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).
Not Weighing Your Options
There are many options to choose from with Medicare. There’s Original Medicare, Medicare Advantage, and Medicare Supplement Plans. It’s important that you know the differences and their benefits. If you make the mistake of not weighing your options you can leave yourself with large gaps in your coverage or end up paying far more than you need. Below we’ve outlined these plans to give you a starting point.
Original Medicare
Original Medicare, also known as traditional Medicare, consists of only Parts A and B. Medicare Part A is hospital insurance, and it covers hospital inpatient care and skilled nursing facility care. Part A coverage typically includes the following:
Semi-private hospital rooms
Hospital meals
Inpatient lab tests and X-rays
Operating room and recovery room services
Drugs and medical equipment used while in the hospital or skilled nursing facility
ICU care
Skilled nursing services
Hospice care
Part B of Medicare covers your general medical expenses. Such as doctor’s visits, urgent care, and specialists. Typically Part B covers:
Doctor visits and services
Some preventative screenings and services
Ambulance services
Outpatient surgery services
Mental health care
Some durable medical equipment
Some medically necessary tests such as X-rays, MRIs, CT scans, and EKGs
Medicare Advantage
Medicare Advantage, commonly known as Part C, is a type of Medicare plan that is offered by private insurance companies. These companies have a contract with the Medicare program that ensures the plans they offer comply with Medicare’s regulations. Medicare pays a set amount to the insurers for each participant enrolled in the plan. Additionally, you will pay your medical bills directly to your insurance company while your insurance provider must follow Medicare’s regulations. They are allowed to set their own rules for out-of-pocket expenses as well as decide if you need a referral to see specialists.
Medicare Supplement Plans
Medicare Supplement Plans are plans that you can buy to supplement your Original Medicare. These plans fill in any gaps in coverage, ensuring you get the most coverage for all the medical needs you specifically have. You do have to pay a monthly premium for these plans, and you must enroll in both Part A and Part B to be eligible for a Medicare Supplement Plan. However you may end up paying less than you would overall with your Original Medicare because Medicare Supplement Plans all have benefits that cover a lot of the out-of-pocket costs for Part A and B. One of the biggest advantages with Medicare Supplement is the variety. There are 10 plans to choose from and all of them cover different benefits at different amounts. It’s important you look through these plans and compare to tailor your coverage specifically to what you need.
Working With EZ
In order to save as much as possible during your Medicare journey, it’s important to keep all of these mistakes in mind. You can rely on EZ if you have any questions or need help choosing your plans. Whether you’re looking for help enrolling, or just need some information. Give us a call today at 877-670-3608 to speak to your own Medicare Agent or you can get free instant quotes by entering your zip code in the box below.
If you’re healthy, you might not think you need health insurance. You might look at it as an unnecessary expense – but health insurance can be affordable! That is not the only reason you should get it, though. Having a plan offers financial protection in case of an emergency or in the event you do get sick, and will mean not having to worry about a large bill after seeing the doctor. It can also help keep you healthy, if you know how to take advantage of your benefits. Check out the many free benefits and ways to save that your plan offers.
Preventive Care
Most ACA-approved insurance plans cover a set of preventive services. Preventive care benefits will help you stay healthy, and what’s best about them is that most are free. With your healthcare plan, you can go to the doctor for an annual wellness visit, during which your doctor will conduct exams, screenings and offer any necessary immunizations. Your doctor can screen you for multiple conditions during your exam, including:
Health insurance plans will provide preventive care, such as screening for depression, and providing counseling for it.
One of the biggest perks you can get with insurance? The discounts and rebates! Your plan might offer the following:
Some plans will offer gym membership stipends.
Gym membership stipends- some plans offer a stipend that pays a portion of your monthly gym membership.
Smoking cessation help– some plans cover medication to help you quit smoking.
Weight loss counseling– some plans offer rebates for weight loss programs.
Free Medical Equipment
Did you know that some plans offer free medical equipment? If you get injured or are sick, you could be covered for crutches, walkers, and oxygen supplies. Health insurance plans will also offer diabetic supplies for free. And if you have a baby? Many women are unaware that they can get a breast pump for free!
Being healthy does not mean you do not need health insurance; in fact, the best time to get insurance is when you’re healthy! The right plan can offer you many freebies to take advantage of, including the preventive care you need to stay healthy. In addition, if you are healthy, your health plan will be more affordable, especially if you consider a high deductible health plan. EZ.Insure’s agents work with many insurance companies in the country, which allows us to compare plans in your area in minutes. We will find you an affordable plan that will protect you against the unexpected, while saving you money on things you want, like gym memberships. To get free instant quotes, enter your zip code in the bar above, or to speak with one of our licensed agents, call 888-350-1890.
