Janis Turner serves as the admissions coordinator for Elsie Gayer Healthcare Center at Baptist Retirement Community in San Angelo. She’s worked in senior living and retirement services for 23 years, and today she’s sharing the most common misconceptions about Medicare.
Medicare is like technology: always changing, different for everyone, and most beneficial when you understand exactly what it is. Through the years, I’ve seen the following misunderstandings surface again and again among Medicare patients and their families.
Myth #1: All Medicare is created equal
Not all Medicare is the same. In fact, Medicare serves senior adults (age 65 and older) through four completely different parts: A, B, C and D. Here’s a simplified breakdown of each and what function they serve:
- Part A: Covers hospital and temporary inpatient care
- Part B: Covers outpatient costs (doctor visits, specialists, immunizations, etc.)
- Part C: Medicare advantage plan combining Parts A and B
- Part D: Covers prescription drugs
Myth #2: Medicare pays for everything
Medicare does not pay for everything. Rarely will Medicare cover a full medical expense. Most visits still require a copay, and while supplemental insurance providers usually cover these, it’s not a guarantee. Medicare also does not pay for long-term care in a skilled nursing facility. This is paid for privately by the resident and/or state Medicaid programs or long-term care insurance. Lastly, the only way Medicare will contribute to medication and prescription costs is if the patient is admitted or elects the Medicare D plan.
Myth #3: Medicare and Medicaid are the same
Medicare and Medicaid are not the same programs. Medicare is federally run and determines coverage based on the senior adult’s years of working and paying into the program. Medicaid, however, is state run and carries different coverage plans from state to state. In Texas, senior adults can only qualify for nursing home Medicaid if they meet the financial requirements (based on both income and assets) and prove a medical necessity for licensed care by a licensed nurse.
Myth #4: Medicare patients must receive care from where their doctor suggests
When it comes to choosing a care provider or nursing facility, Medicare patients are not required to go where their doctor tells them. Senior adults and their families can freely choose the Medicare licensed facility from which they would like to receive nursing services. A doctor can of course recommend facilities he or she supports, but the decision is ultimately up to the individual. Patients also can choose their doctors as long as the doctor participates in the Medicare program.
For additional resources, visit www.medicare.gov or call 1-800-medicare. You can also call Buckner Retirement Services at 1-800-381-4551 for specific questions regarding your coverage.