Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.
The Ask Phil (e)mailbox has been overflowing of late. I will get to as many questions as I can here, but please accept my apologies that I am not able to answer everyone’s questions.
Mike – Tex.: I will turn 65 next year and understand Medicare does not cover vision, hearing and dental needs. How would you suggest Medicare recipients cover these requirements?
Phil Moeller: Mike highlights one of the major missing pieces of basic Medicare coverage. This is a big deal. The failure to get regular care in any of these areas can lead to serious health issues in later life that could cost a lot of money, not to mention reducing the quality of life in those later years.
Parts A and B of Medicare will cover some surgeries involving these needs but not routine and ongoing care. Here are explanations from the agency’s website of what it does and doesn’t cover.
Medicare doesn’t cover routine eye exams (sometimes called “eye refractions”) for eyeglasses or contact lenses. Medicare Part B covers some surgical, preventive and diagnostic eye exams:
- Yearly eye exam but only for those with diabetes.
- Glaucoma tests for people at high risk for glaucoma.
- Macular degeneration for those with this condition.
- Cataract surgery (including a pair of corrective lenses if required after surgery).
Medicare Part B covers diagnostic hearing and balance exams if your doctor or other health care provider orders these tests to see if you need medical treatment.
Medicare doesn’t cover hearing exams, hearing aids or exams for fitting hearing aids.
Medicare doesn’t cover most dental care, dental procedures or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates or other dental devices. Medicare Part A (hospital insurance) will pay for certain dental services that you get when you’re in a hospital. Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures even though the dental care isn’t covered.
Although basic Medicare does not cover these items, many Medicare Advantage plans do. Mike, I’d advise you to take a look at Medicare Advantage plans available where you live and look at their coverage of these items.
Many people like basic Medicare because it allows them great freedom in choosing their doctors, other care providers and hospitals. Medicare Advantage plans usually require their customers to use providers within the plan’s network or pay higher costs for out-of-network care. If basic Medicare is attractive to you, then you’d need to look elsewhere for your vision, hearing and dental insurance. There are private insurance plans outside of Medicare that will cover these items through separate insurance policies.
This may seem like a lot of work. But if you sit down at your computer and search for available policies, you can quickly get an idea of costs. If it was my choice, I’d find an insurance broker who can quickly compare several policies for you and generate a quote for the coverage options you want.
Karen – Tex.: I will turn 65 this year. I am currently employed as a teacher and do not have any plans to retire. I am already retired from local/state government and my health insurance is through the Employees Retirement System of Texas (ERS). Must I apply for Medicare, and will my insurance disappear on my birthday? Also, if I do have to apply, do I apply for all parts A, B, C and D?
Phil Moeller: Even though you are still working, your note indicates that your health insurance is not coming from an active employer group plan but from your retiree plan. While continued participation in an active employer plan would shield you from having to get Medicare when you turn 65, that’s not the case with a retiree plan. So I’m afraid that you will need to sign up for Medicare and that you should explore doing so before you turn 65. Under the rules of your Texas ERS retirement plan, Medicare will become the primary payer of your health insurance claims when you turn 65, and Texas ERS will become the secondary, or back-up, payer. You don’t want to risk having a break in your insurance coverage. The good news here is that after you get Parts A and B of Medicare, Texas ERS will automatically move you to a Medicare Advantage plan offered by Humana. “The plan, a combination of Medicare and your state health plan, covers most or all of your medical expenses,” the Texas ERS website says. So while you likely will pay monthly premiums for Part B, the Humana plan will include Part D drug coverage. And you won’t need a Medigap policy, because Medicare Advantage plans offer similar features that plug coverage gaps in the coverage provided by Parts A and B of Medicare.
Anna: My husband is 64 years old. He is retired from the Air Force. We were told that three months before he turns 65 we need to file for Medicare Parts A and B. Then we need to provide proof to Tricare that he is covered by Medicare. At that time, his Tricare will be converted to Tricare for Life. Since he will have Medicare and Tricare for Life as his secondary insurance, will we also need to apply for a Medigap policy, or does Tricare for Life function as the Medigap policy?
Phil Moeller: Tricare for Life does a good job of plugging coverage gaps in original Medicare, so you should not need a Medigap policy. However, I’d check with Tricare to make sure it covers all the things you’d want from a Medicare supplement policy. Also, Medicare covers individuals, not families. But one of the wonderful features of Tricare is that you can remain on your current Tricare plan until you also turn 65 at which point you also can move to Tricare for Life. If you have any children covered by Tricare, they, too, can remain on their plan even though your husband is now using Medicare as his primary insurer. Children can remain on Tricare until they turn 21 or up to age 23 if a full-time student. And up until 26, they can continue to be covered under the Tricare Young Adult program.
Bob – Pa.: I am 63 years old. After 43 years of work, I had to have major back surgery, could no longer work and was granted disability benefits. My wife is 57, and I have a 22-year-old daughter in school at home. I was able to purchase a good health insurance plan through the Affordable Care Act that covers all of us. I was told that I will have to accept Medicare after two years on disability, which will be this November. Do I have to take Medicare? I am concerned that on our reduced income I will have to pay for Medicare and purchase a health care plan for my wife and daughter, which I think will cost me even more. Is that true, or can I continue to only have the health insurance that I currently have and decline Medicare without fear of any penalty or restrictions if I get Medicare later in life?
Phil Moeller: Before passage of the Affordable Care Act, someone in Bob’s position most likely would have been grateful to get Medicare under any circumstances. Private health insurance for someone with his medical history would have been unaffordable or, more likely, not even available. The ACA’s protection against being denied coverage due to preexisting conditions has been great news for millions of people. But it has, ironically, placed Bob in a bind. He might well be better off staying on the ACA plan he purchased through the Pennsylvania state insurance exchange.
Unfortunately, Bob, the rules for continued participation in ACA plans are clear and strict. Taking Medicare disqualifies people from continued ACA coverage. They must get Medicare. Your wife and daughter are free to stay on their exchange plan. The only basis for rejecting Medicare would be if you had not worked long enough to qualify for premium-free Part A of Medicare, which covers hospital expenses. But after 43 years of work, and having already qualified for Social Security disability, this clearly is not the case. If your family income is low enough, it’s quite possible you could pay less for Medicare than you think. The program has a series of Medicare Savings Programs for lower-income beneficiaries. And there also is an “Extra Help” program to help pay for Part D prescription drug plan costs.