Medicare Doesn’t Cover Everything – GA Medicare Expert Explains

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How does original Medicare work? Are you turning 65? Enrolling in Medicare? Medicare doesn't cover everything. Here is a partial list of what is not paid by Medicare. GA Medicare expert Bob Vineyard, insurance agent

Routine dental care, dentures, crowns, bridges, routine eye exams, eyeglasses, contacts, cosmetic surgery unrelated to illness or injury, OTC vitamins and supplements, hearing exams, hearing aids, long term care, medical treatment outside the country.

Most of these items were not covered by your employer group health plan either. Things like vision, dental and hearing were covered by insurance plans OTHER THAN your major medical. You probably had a separate plan for dental and another for vision care.

Different policy.

Different insurance carrier.

In many cases you can purchase separate insurance coverage for the following.

– dental care
– vision care
– contacts
– eyeglasses
– hearing exams and hearing aids
– hearing loss
– international travel medical
– hospital indemnity
– cancer plans
– critical illness

The list goes on.

But before spending good money on these kinds of insurance, ask yourself if you really need it?

Do you need to spend $40 – $60 per month for a dental plan that limits your annual benefit to $1,000?

Do you need to pay monthly premiums of $50 per month for a plan that pays $600 per day for inpatient care only?

Most people would be better off stuffing that money in a mattress than paying for additional insurance that may never pay off.

Part B is for outpatient health care treatment. Doctor visits, labs, X-rays, MRI, CT scan (CAT scan), ambulance, ER, outpatient clinics, etc. Essentially any Medicare approved health care received outside the hospital setting. Treatment considered medically necessary under Medicare guidelines. Medicare Part B has a calendar year deductible. Once satisfied, Medicare pays 80% of the approved charge, you are responsible for the remaining 20%.

Most seniors worry about hospital stays, but your major expenses will more than likely fall under Medicare Part B outpatient expenses. Original Medicare stand alone has no cap on your out of pocket expenses.

You pay until you run out of money, get well or die.

The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.

Not all cancer responds to chemotherapy, but 80% of cancers are treated with chemo. Those treatments occur in an outpatient setting and are covered under Medicare Part B.

Chemotherapy drugs administered in a doctor's office or clinic normally fall under Part B. Medication from a retail pharmacy or by mail fall under your PDP.

This is why most of us chose a Medicare supplement plan in 2018. Bob Vineyard, independent Medicare insurance broker in Georgia, can explain your Georgia Medicare insurance options and will allow you to decide.

We represent several carriers including Aetna, Anthem Blue Cross, Humana and more.

According to the Mayo clinic, "new cancer treatments are routinely priced at over $100,000 per year of treatment."

I enrolled in Medicare in September, 2015. Cancer is a word I know too well. My mothers twin sister and older sister died of cancer. My wife’s father and mother died because of cancer. All 5 of my father-in-laws siblings died of cancer. Two of my mother-in-laws siblings died of cancer.

I have seen what cancer can do to the human body and the misery that accompanies this dread illness. If you are diagnosed with cancer, the last thing on your mind should not be “How will I pay for my treatment?”

I know how quickly things can change. When my health changes I want to control the direction of my care. Insurance carriers are not going to give me a list of doctors and tell me this year I can only use these, and next year the list may change.

Some cancer centers do not accept ANY Medicare Advantage plans.

A study from the Medicare Rights discovered the number one reason for disenrolling from a Medicare Advantage plan was “provider access problems”. Number 4 on the list was “cost sharing too high”.

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How does Medicare work? It does not cover everything.

Medicare Doesn't Cover Everything – GA Medicare Expert Explains

 

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