Dealing with an age-related illness can be difficult. These conditions occur more often in people as time passes, and their age can become a critical factor. Fortunately, you have many services and treatments that can be covered with Medicare insurance. While you will have some out-of-pocket costs, you can also find additional coverage to your Medicare benefits with the help of Advantage plans or Medicare Supplements. 

First, let’s look at what Medicare covers regarding these types of illnesses and conditions and what that coverage looks entails.

Medicare Part A coverage

Some age-related illnesses include dementia, arthritis, cataracts, and osteoporosis. As we age, our bodies can become weaker and take longer to heal. The symptoms of these conditions can be painful and hard to live with daily. Thankfully, Medicare Part A provides some coverage for many helpful services such as inpatient hospital stay, home health care, skilled nursing, or hospice care.

What does Part B cover?

Part B takes care of your outpatient services, such as outpatient surgeries, lab work, and physical therapy. For example, if you have arthritis and your doctor recommends a surgery like a hip or knee replacement, Part B would help pay for the surgery and any necessary physical therapy afterward.

Are my prescriptions covered?

There are many medications available to people with age-related illnesses. These prescription drugs can help treat or manage a condition or disease. Prescriptions you pick up at a pharmacy get covered under Medicare Part D or a Medicare Advantage plan if it includes drug coverage. Beneficiaries can enroll in a Part D prescription plan to help with the cost of these drugs.

What does Medicare not cover?

Regarding age-related illnesses, it’s essential to know that Medicare does not cover long-term care. If an age-related illness is sending you or a loved one to the point where you need an assisted living facility, Medicare will not cover it. Many of these places provide “custodial care,” which includes help with tasks like bathing, eating, and getting dressed. However, if you find yourself in this facility, Medicare will still cover your approved medical needs under Part A and Part B.

The main takeaway when it comes to Medicare is they will not cover a treatment or service if it is not medically necessary.

What will I pay?

Medicare will pay for some of these services and treatments but not everything. Let’s break down what could be coming out of your pocket:

Part A

When it comes to Part A, you are responsible for the Part A deductible before it begins providing coverage for your inpatient hospital stay ($1556 in 2022). This deductible is per benefit period, which is every 60 days you have not been in the hospital.

If you need a skilled nursing facility stay, Medicare will provide coverage for the first 20 days, and you will have a daily copay for the remaining 21-100 days. The daily copay amount in 2022 is $194.50.

Part B

Part B has a monthly premium that everyone must pay. Most people pay the standard amount ($170.10 in 2022), but if your income is higher, you could have to pay more for your Part B premiums.

Part B also has a yearly deductible. For 2022, it is $233. Once you meet the deductible, Part B pays for 80% of your Medicare Part B services and treatments. With no cap, you will then be responsible for the remaining 20% of the costs.

Part D

Deductibles, copays, and coinsurance are associated with these plans, but you can shop for a new plan each year to ensure you have a cost-effective rate and that your plan covers all your medications.

Additional Coverage

When enrolled in Medicare, you have two options for secondary coverage. You can apply for a Medigap or Medicare Advantage plan. This additional coverage can help with your out-of-pocket costs so you can focus more on your medical needs.

Medigap

A Medigap plan pays secondary to Medicare and helps cover the remaining 20% after Medicare pays its 80%. As long as Medicare approves and pays for a service or treatment, a Medigap plan will too. These plans do not offer coverage for your prescriptions, so you would want to enroll in a standalone Part D plan.

Medicare Advantage

Medicare Advantage plans are an alternative option through private insurance carriers. If you enroll in this plan, your Part A and B benefits come from your Advantage plan. Many Medicare Advantage plans have a Part D drug plan attached as well. These plans provide a network of doctors and pharmacies who must accept your plan to receive coverage.

Although Advantage plans provide coverage differently, both options can assist you with your costs.

Help is there

Age-related illnesses can be challenging to deal with, but it’s important to know that if you are enrolled in Medicare, there is some coverage for you. Enrolling in a Medigap or Medicare Advantage plan can also help alleviate some of those out-of-pocket costs Medicare leaves you with so that you aren’t drowning in medical debt while trying to manage your condition.