7 Things Social Workers Need to Know About Medicare

#1 We Can Protect Seniors from Bankruptcy

Over-65 healthcare costs are high, averaging $290,000 per person. 20% of all medical bankruptcy filers are people over the age of 55. (Source: The Balance).

One study has claimed that 62.1% of bankruptcies were caused by medical issues. 

How do we prevent medical bills from bankrupting people? They need to get the best health coverage they can afford.

People who qualify for Medicaid may qualify for a zero premium Medicare plan that will limit their maximum out-of-pocket medical expenses and prevent bankruptcy.

And for those under 65, ACA (Obamacare) plans have made a huge impact in lowering healthcare-related bankruptcies for those who take advantage of them.

The average couple that retires at the age of 65 can expect to pay $275,000 in medical bills for the remainder of their life. 

Even those aware of how expensive retirement is are often shocked by this discovery once they’re met with illness and absurd hospital bills. This is why the number one cause of bankruptcies among seniors is healthcare expenses.

For a ton of facts and statistics about medical bankruptcy, read this.

Social workers need to know the ins and outs of Medicare to save their senior clients from unnecessary stress.

#2 Original Medicare isn’t free, doesn’t cover everything, and has no cap on what you have to pay.

People who simply opt-in to Part A and Part B of Medicare are still vulnerable. There is no maximum out-of-pocket for what you will have to pay. The average senior who requires a hospital stay will owe $206,000, and original Medicare will only cover 80% of that, leaving the senior responsible for more than a $40,000 bill.

But it’s not only long hospital stays that can hurt. Short-term stays are what cause issues with medical bills in 66% of the cases. (Source: Kaiser Family Foundation)

How do you get more coverage? A Medigap or Medicare Advantage plan. Getting the right one of these for you is always a good idea when you opt into Medicare.

#3 There are zero-premium plans with an out-of-pocket maximum.

Make sure that the Maximum Out of Pocket number is part of the discussion in getting the right plan. As we explained above, surprising and expensive medical bills can have a devastating affect on seniors, so you need to make sure that a Medigap or MedAdvantage plan is limiting your exposure to these kinds of risks.

#4 Having a low income or chronic illness can qualify you for more benefits. 

There is a lot available to help people who are near or under the Federal Poverty Level. These benefits may include prescription discounts, dental, vision and hearing, gym membership, plus grocery cards and OTC cards with monthly allowances so you can increase your purchasing power.

Programs  that help with these things include Extra Help, Medicaid, and Medicare Advantage plans

#5 Long-term care is barely covered without an additional policy.

The average over-65 nursing care stay costs $206,000. A long term care or hospital indemnity plan can prevent people from going bankrupt. 

Typically, people who go with  a Med Supp (Medigap) plan can really benefit from adding on a Critical Illness, Cancer, or Heart/Stroke plan. And those who opt for Medicare Advantage get additional protection from a Hospital Indemnity plan.

#6 There are lifetime penalties for signing up late to Parts B or D.

Make sure you know when people can and should enroll. The simplest advise is to enroll as soon as you can. There won’t be penalties if you have creditable employer health coverage… but veterans need to be careful, because the VA is not creditable for Part B, though it is for Part D.

However, if you have TRICARE For Like, that is a different situation- talk to us or other experts to make sure you make the right moves with Medicare.

Read: Part B Penalties, Part D Penalties.

#7 Medicare costs increase every year to keep pace with inflation.

Make sure you budget for this in your retirement plan, if you can. If you have SSI, there is a yearly increase to account for inflation, but some argue that it is not sufficient.

To schedule an appointment to review your situation and see if we can get you better benefits or save you money, contact us today!

Brian Carter

Brian Carter

Brian Carter has been in the health field since 1999, and was a medical terminology teacher at the Master's degree level. He's also a marketer, stand up comedian, and an abstract painter. Brian has a lot going on, but his passion is Medicare and helping seniors with their Medicare and other health insurance. Brian learned from his grandma that how you live your senior years matter, because you may live a lot more of them than you expect... she lived to be 105 years old, and despite being a farmer and school teacher, she lived frugally enough to be able to give to others. She also received a Governor's award for volunteer service at her local Kokomo, Indiana hospital. His mom was a special education teacher, so he had plenty of good role models for living a life of service to others. Brian grew up in Ohio, lived in San Diego, but loves Charleston, SC the best. It's his favorite city in the world. He has a deep love of the land, the rivers, and the people who call this area home. When asked how he feels about seniors, Brian says, "I love old people... I married one! Don't tell my wife I said that."