Medicare 101: Answers to Your Top Five Questions

Medicare is a “federal health insurance for people 65 or older.” Every person who reaches this age has the right to enroll in Medicare to seek coverage for medical services. There are many myths and misconceptions about what Medicare actually is and how it works. At The Law Offices of Odelia Goldberg, we are committed to empowering families and providing solution-driven elder law representation. In this article, our Fort Lauderdale elder law attorney answers five of the most frequently asked questions (FAQs) about Medicare in Florida. 

1. How Does Medicare Coverage Work (Part A, Part B, Part C, and Part D)?

Medicare is the federal government’s primary health insurance program for senior citizens. It is also available for a very limited number of younger people with certain types of disabilities. That being said, Medicare is not just “one thing”—it is made of several different components. Coverage may be available under Part A, Part B, Part C, and/or Part D of the program. Each part covers different services and comes with its own set of costs and coverage details. Here is an overview: 

• Medicare Part A: Often referred to as hospital insurance, Medicare Part A mainly covers inpatient hospital stays. Indeed, it is the cornerstone of basic Medicare coverage. For most beneficiaries, Part A comes without a monthly premium if they or their spouse paid Medicare taxes during their working years. Though, Part A may have a co-pay. 
• Medicare Part B: Your Medicare Part B is your traditional health insurance (medical insurance). Among other things, Medicare Part B covers specific doctor’s services, outpatient care, medical supplies, and preventive services. Unlike Part A, Part B does require a monthly premium that varies based on income. Notably, Medicare Part B’s monthly premium may be as low as $0 per month for low-income individuals. 
• Medicare Part C: More commonly known as Medicare Advantage, Part C is an alternative way to receive your Medicare benefits. It combines Part A and Part B and often includes Part D (prescription drug coverage) and additional benefits that Original Medicare does not cover—like vision and dental. These plans are offered by private insurance companies that have been approved by Medicare. 
• Medicare Part D: Medicare Part D offers prescription drug coverage. Anyone with Medicare (either Original Medicare or Part C) is eligible for Part D. Like Part C, private insurance companies offer these plans. A monthly premium is often associated with Part D plans. There are a number of different federal regulations that apply to Medicare D plans 

2. Can Medicare Deny Coverage for Medical Services?

Yes. A number of different factors will determine whether or not Medicare approves services that a person is seeking. These decisions are often based on the service’s medical necessity and whether or not the care is covered by the specific Medicare plan, or if the provider does not meet Medicare’s standards. While Medicare provides extensive coverage, not all treatments, services, or medications are covered. If a service is deemed not medically necessary but you still wish to receive it, you might be asked to pay all costs. Always ensure that services are approved and covered by Medicare. 

3. Do I Have to Enroll in Medicare to Get Coverage?

Yes. There is an all-too-common misconception that Medicare enrollment is automatic for every person once a person reaches the age of 65. Although some people may be automatically enrolled for Medicare Part A through receipt of Social Security benefits, automatic enrollment is not guaranteed. An eligible person should sign up to enroll in all of the Medicare coverage that they wish to receive as soon as they can qualify. Remember, there are different enrollment periods for Parts A, B, C, and D, and each type of Medicare coverage has its own criteria. 

4. How Do You Give Another Person the Authority to Deal With Medicare?

To allow another person to handle matters related to Medicare on your behalf, you need to provide explicit authorization. Two primary methods are used for this purpose:

• Power of Attorney (POA): A Power of Attorney is a legal document that grants an individual, often referred to as an “agent” or “attorney-in-fact,” the authority to make decisions and take actions on behalf of another person. When tailored specifically for healthcare decisions, a POA can provide the appointed individual the power to deal with Medicare-related matters, including enrollment, plan changes, and claims/appeals.
• Medicare Authorization Form: This is a document provided by Medicare where beneficiaries can designate another person to access personal health information, make inquiries, or file grievances and appeals. To be clear, the form does not grant the authority to make broader medical decisions but allows the designated individual to interact with Medicare on the beneficiary’s behalf. Even when a POA is in place, you should still submit the proper Medicare authorization form. 

5. Does Medicare Cover Long-Term Care (Nursing Homes)?

No—at least not in most cases. Medicare only provides very limited nursing home care coverage. For long-term care coverage in nursing homes, Medicaid is the primary program in the United States that provides coverage. There are significant differences between Medicare and Medicaid. Most notably, Medicaid is a means-tested federal program. In effect, This eligibility is determined, in part, based on an individual’s income and assets. In some cases, a vulnerable person could be required to “spend down” their assets before they can qualify for long-term care/nursing home care coverage through Medicaid. For this reason, proactive long-term care planning is an absolute must. An experienced Fort Lauderdale elder law attorney can help you put the right plan in place.

Contact Our Fort Lauderdale Elder Lawyer for a Confidential Consultation 

At The Law Offices of Odelia Goldberg, our Fort Lauderdale elder law attorney provides reliable, solution-focused legal guidance to clients. If you have any questions about Medicare, we are here to help. Contact our legal team today to request your confidential consultation. With a law office in Fort Lauderdale, we provide elder law support in Broward County and throughout South Florida.