Over 65 million seniors across the United States benefit from Medicare – a federal health insurance program.
WHEN CAN YOU APPLY FOR MEDICARE?
At age 65, you become eligible for Medicare if you are a U.S. citizen. You can enroll in Medicare 3 months prior to your 65th birthday, the month of your 65th birthday, or any time during the 3 months that follow your 65th birthday. You do not have to be retired in order to apply.
Certain individuals may be able to obtain Medicare coverage prior to age 65. For example, individuals with end-stage renal disease, ALS, or a disability, could qualify.
WHAT ARE THE MAIN PARTS OF MEDICARE?
Medicare consists of different parts that address different aspects of healthcare needs:
- Part A covers institutional care in hospitals and skilled nursing facilities.
- Part B pays for doctor visits and preventative care. This includes routine lab tests and certain outpatient treatments. Parts A and B serve as the so-called “traditional” parts of Medicare.
- Traditional Medicare, Medicare Part C, or Medicare Advantage. Part C plans bundle Parts A and B (and sometimes Part D) with other benefits, such as dental or vision care.
- Medicare Part D coverage (this is oftentimes optional) covers many of your prescription medications.
MEDICARE UPDATES YOU SHOULD KNOW ABOUT IN 2024
As of January 1, 2024, Medicare enrollees should be aware of 5 updates:
1. MONTHLY SERVICES FOR CHRONIC PAIN SUFFERERS
For the first time, people receiving Medicare who have persistent or recurring pain (lasting longer than three months) now can have services like medication management and pain assessment covered by their Medicare plan. For those using these services, it is important to keep in mind that your Medicare Part B deductible and coinsurance still apply.
2. MEDICARE’S MENTAL HEALTH COVERAGE
Medicare will now cover up to 19 hours per week for intensive outpatient mental health care for qualifying patients.
If you need a licensed mental health provider, you will be more likely to able to find a professional near you who accepts Medicare due to an estimated 400,000 nationwide providers being added, including marriage and family therapists as well as mental health counselors.
Medicare can now help if you require treatment for alcohol abuse or substance use disorder. Older Americans are currently suffering from a substance abuse epidemic. In 2022, roughly 4 million seniors aged 65 and older were living with an addiction. Medicare now covers treatments for such services as psychotherapy, prescription drugs, and screenings.
3. SAVINGS ON SPECIALTY MEDICATIONS IN 2024
Many people rely on certain expensive medications to treat such serious health conditions as cancer. Even with Medicare Part D, they may have no choice but to pay tens of thousands of dollars out of pocket annually.
If your prescription drugs covered by Medicare cost you more than $8,000 out of pocket, you will not be responsible for any other co-pays or coinsurance for the remainder of the calendar year. This is because Medicare Part D enrollees, as of 2024, will no longer have to pay a 5 percent co-pay for catastrophic coverage.
For those relying solely on brand-name prescriptions, you will end up spending roughly $3,300 out of pocket to avoid the 5 percent co-pay. However, in 2025, Part D enrollees will not pay more than $2,000 out of pocket for their prescription drugs in any given year.
4. SUPPORT IN PAYING MEDICARE PART D PREMIUMS
As of the start of 2024, the Medicare Extra Help Program will strive to boost its number of enrollees through various outreach efforts. Extra Help assists low-income seniors and people with disabilities. However, many who are eligible do not currently participate in the program due to lack of awareness about the program.
In addition, another 300,000 individuals who already are part of the program will see their benefits expand further. These individuals will see their out-of-pocket costs for their prescriptions drop by an average of $300 a year, and they will not have to pay a premium or deductible.
5. $35 CAP PER MONTH FOR INSULIN SUPPLIES COVERED BY MEDICARE PART D
As part of the Inflation Reduction Act, price cuts on insulin became effective on January 1, 2024. Medicare Part D plans therefore cannot charge enrollees more than $35 per month for insulin included in their plan. Also, Part D deductibles for insulin supplies will no longer apply.
The cost of this medication has tripled over the past decade or so. Even for people who require insulin daily, many are still unable to afford it. In 2022, more than a million individuals with diabetes chose to ration their insulin supply because of the cost, according to one report.
Medicare plays a vital role in providing essential healthcare coverage for millions of seniors in the United States. Understanding when and how to apply for Medicare, as well as its various parts, is essential for accessing the care you need and deserve. As you navigate your Medicare journey, remember that being well-informed and proactive in exploring your options can lead to better health outcomes and financial security.
WORK WITH A QUALIFIED ELDER LAW ATTORNEY
If you are finding the process of navigating Medicare to be overwhelming, you should consider reaching out to your elder law attorney today. They can help you understand how to apply for or qualify for Medicare benefits.
Bromlow Law, PLLC and Laura L. Bromlow, are dedicated to the practice of Elder Law and Estate Planning. Our practice focuses solely on working with clients in these and closely related legal fields. Laura L. Bromlow is a Certified Elder Law Attorney with the National Elder Law Foundation. Bromlow Law, PLLC strives to enhance communication among family members and loved ones and to keep them all out of conflict so they can stay out of court. We want to help you keep your close circle safe!
Please contact our office today at (281) 665-3807 to schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.