5 Things Medicare Doesn't Cover (and how to get them covered)

Medicare Specialist - Abt Insurance Agency
12 Jul 202210:17
EducationalLearning
32 Likes 10 Comments

TLDRThe video script by Stephanie Abt highlights common surprises regarding Medicare coverage, emphasizing five key areas not covered by traditional Medicare: eye exams, hearing aids, dental services, full routine physical examinations, and nursing/home long-term care. It suggests solutions like Medicare Advantage plans, supplemental insurance, and discount programs to mitigate out-of-pocket expenses, and encourages viewers to understand their options and potential costs before utilizing services.

Takeaways
  • 📜 Medicare is divided into Part A (hospital insurance) and Part B (medical insurance), covering most medically necessary services with some cost-sharing involved.
  • 👶 Traditional Medicare does not cover routine eye exams, glasses, or contact lenses, though some Medicare Advantage plans may offer vision benefits.
  • 🎧 Medicare does not cover routine hearing tests or hearing aids, but there are discount plans and programs available to help reduce costs for those with hearing needs.
  • 🦷 Dental services, including exams and work, are not covered by traditional Medicare, but some Medicare Advantage plans may include dental benefits or standalone dental plans can be purchased.
  • 🩺 Traditional Medicare has limited coverage for annual physical examinations; it covers a Medicare wellness exam instead of a full routine physical with blood work.
  • 🏥 Medicare covers a limited stay in a skilled nursing facility but does not cover long-term care or custodial care for daily living activities.
  • 💰 The average annual cost for a nursing home can be around $90,000 to $100,000, and Medicare does not cover this, so planning for such expenses is crucial.
  • 🤝 There are various types of plans available for those on Medicare, including Medicare Advantage, Medicare Supplement plans, and different options for additional coverage.
  • 📈 It's important to understand potential out-of-pocket costs before starting to use Medicare benefits and to consider different plans available based on individual needs and budget.
  • 🌐 For personalized advice and quotes on Medicare Supplement plans, one can consult with independent brokers who can provide unbiased assistance.
  • 📹 The video provides tips and solutions on how to potentially get coverage for services not covered by traditional Medicare, emphasizing the importance of being informed before seeking care.
Q & A

  • What are some common services that Medicare does not cover?

    -Medicare does not cover routine eye exams, glasses, contact lenses, hearing aids, dental exams or work, and full routine annual physical examinations that include blood work.

  • What does Medicare cover under Part A and Part B?

    -Part A covers hospital insurance, while Part B covers medical insurance. Together, they cover most medically necessary services, including ER visits, doctor's office visits, hospital stays, diagnostic testing, and non-self-administered medications.

  • What is the difference between a Medicare wellness exam and a routine physical examination?

    -A Medicare wellness exam is a pared-down version of a routine physical examination. Medicare covers the wellness exam at 100%, but a full routine physical exam with blood work is not covered under traditional Medicare unless you have additional coverage.

  • How can one prepare for potential out-of-pocket costs when using Medicare?

    -It's important to be aware of the different types of plans available, such as Medicare Advantage plans, Medicare supplement plans, and to understand their coverage details to avoid unexpected medical bills.

  • What are some options for individuals who need dental coverage?

    -Some Medicare Advantage plans include dental benefits, standalone dental plans can be purchased, and dental discount plans are available for seniors. Additionally, Medicaid may help those with limited income and savings.

  • How can one reduce the cost of hearing aids if Medicare does not cover them?

    -Individuals can check if their Medicare Advantage plan covers hearing aids, look into purchasing a discount plan, or explore programs that assist low-income individuals with their hearing needs.

  • What is the average annual cost for nursing home care in the U.S.?

    -The average annual cost for nursing home care in many parts of the U.S. is about $90,000 to $100,000.

  • How can one get coverage for vision expenses if Medicare does not cover them?

    -Some Medicare Advantage plans may include vision benefits, or individuals can purchase a separate vision insurance policy. However, most vision plans have an annual maximum benefit cap.

  • What is the role of a financial advisor in planning for healthcare expenses?

    -A financial advisor can help individuals plan for potential future healthcare expenses, such as long-term care costs, by advising on budgeting, saving, or purchasing long-term care insurance.

  • How can one find the right Medicare supplement plan?

    -One can consult with independent brokers who specialize in Medicare plans, conduct a needs analysis, and review personal needs and budget to find the best fitting solution.

  • What services does the speaker's team offer to help with Medicare decisions?

    -The speaker's team offers free, no-obligation quotes on Medicare supplement plans, assists in understanding different types of plans, and helps individuals decide between traditional Medicare, Medigap, or Medicare Advantage plans.

Outlines
00:00
📜 Understanding Medicare Coverage Gaps

This paragraph discusses the surprising gaps in Medicare coverage, emphasizing the importance of being aware of services not covered by traditional Medicare. The speaker, Stephanie Abt, shares that while Medicare parts A and B cover most medically necessary services, there are exceptions such as routine eye exams, glasses, contact lenses, and hearing aids. She also mentions that while some Medicare Advantage plans may offer additional coverage, it's crucial to understand the potential for out-of-pocket expenses and to consider supplemental insurance or plans to mitigate these costs.

05:05
🦷 Dental, Vision, and Hearing Coverage

In this paragraph, the focus is on the lack of dental, vision, and hearing coverage under traditional Medicare. It is highlighted that Medicare does not cover dental exams, work, or hearing aids, although some Medicare Advantage plans may include these benefits. The speaker advises on the availability of standalone dental plans, vision insurance policies, and discount plans to help with these expenses. Additionally, the paragraph touches on the recent legislation allowing over-the-counter hearing aids and programs to assist low-income individuals with hearing needs.

Mindmap
Keywords
💡Medicare
Medicare is a federal health insurance program in the United States that primarily serves individuals aged 65 and older, as well as certain younger individuals with disabilities. In the video, it is discussed that while Medicare covers many medically necessary services through Parts A and B, there are several services it does not cover, leading to the need for additional insurance or payment strategies.
💡Medicare Supplement Plan
A Medicare Supplement Plan, also known as Medigap, is designed to help cover the out-of-pocket costs that come with Original Medicare (Part A and Part B), such as copayments, coinsurance, and deductibles. These plans are not managed by Medicare but by private insurance companies. The video suggests that these plans might help cover some of the services not included in traditional Medicare.
💡Medicare Advantage Plans
Medicare Advantage Plans are offered by private insurance companies and are an alternative way to get Medicare Part A (Hospital Insurance), Part B (Medical Insurance), and usually Part D (prescription drug coverage). These plans often include additional benefits that Original Medicare does not cover, such as vision, hearing, and dental coverage. However, they typically require choosing a network of doctors and hospitals to use.
💡Co-Insurance
Co-insurance is a form of cost-sharing where the insured person pays a percentage of the cost of a covered health care service or supply after meeting a deductible. In the context of Medicare, co-insurance is one of the out-of-pocket costs that beneficiaries may be responsible for after reaching the deductible.
💡Deductible
A deductible is the amount of money that an insured person must pay out-of-pocket for health care services before their insurance plan begins to pay. In the context of Medicare, this is the initial amount that a beneficiary must pay for covered services before Medicare starts covering costs.
💡Eye Exams
Eye exams are medical examinations performed by an eye care professional to assess vision and eye health. While Medicare covers certain eye-related medical procedures like cataract surgery and glaucoma treatment, it does not cover routine eye exams, glasses, or contact lenses.
💡Hearing Aids
Hearing aids are devices that are worn in or behind the ear and are designed to amplify sound, making it easier for individuals with hearing loss to hear. Although Medicare covers medical conditions related to the ear, it does not cover routine hearing tests or the cost of hearing aids.
💡Dental Services
Dental services encompass a range of procedures and treatments performed to maintain or improve oral health, including dental exams, cleanings, fillings, and other restorative procedures. Medicare does not cover dental exams or dental work, which means beneficiaries need to seek alternative coverage options like standalone dental plans or dental discount plans.
💡Annual Physical Examination
An annual physical examination is a comprehensive medical check-up that typically includes a review of medical history, vital signs measurement, and a variety of tests to assess overall health. While traditional Medicare does not cover a full routine annual physical examination, it does cover a Medicare wellness exam, which is a specific type of exam designed to detect and prevent health issues.
💡Long-Term Care
Long-term care refers to a range of services and supports for individuals who have chronic conditions, disabilities, or functional limitations and need assistance with the activities of daily living, such as bathing, dressing, and eating. Unlike Medicare's coverage for short-term skilled nursing facility stays, long-term care costs are not covered by traditional Medicare or Medicare Advantage Plans.
Highlights

Medicare does not cover routine eye exams, glasses, or contact lenses, but does cover cataract surgery and glaucoma treatment.

Some Medicare Advantage plans include vision benefits, and vision insurance policies can offset costs, with an annual maximum benefit typically around $150 to $200.

Traditional Medicare does not cover routine hearing tests or hearing aids, but some Medicare Advantage plans may offer coverage.

For hearing needs not covered by traditional Medicare, discount plans or over-the-counter hearing aids are options, and there are programs for low-income individuals.

Medicare does not cover dental exams or work, and options for dental coverage include Medicare Advantage plans, standalone dental plans, or dental discount plans.

Traditional Medicare has limited coverage for a full routine annual physical examination, instead covering a Medicare wellness exam at 100%.

A full routine physical exam with blood work is not covered by traditional Medicare and may be out-of-pocket, depending on the plan.

Medicare does not cover nursing home care or long-term care, which includes help with daily living activities.

The average annual cost for nursing home care is about $90,000 to $100,000, and planning for such expenses is crucial.

Medicaid can help with long-term care expenses for those with limited income and savings.

Different types of plans like Medicare Advantage and Medicare Supplement plans are available, and understanding them is essential for managing out-of-pocket costs.

APT Insurance Agency offers free, no-obligation quotes on Medicare supplement plans and assistance in choosing the best plan.

Independent brokers can provide unbiased advice on choosing between traditional Medicare, Medigap, or Medicare Advantage plans.

It is important to take advantage of Medicare benefits, including the annual wellness exam, to manage healthcare costs effectively.

The medical community has questioned the value of full routine physical examinations due to over-testing, false positives, and unnecessary medical costs.

Transcripts

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