Medicare Coverage Gaps | Medigap Coverage

Medicare Coverage

The Medicare Gap in Coverage

If you are on Medicare alone, you know that there are gaps in Medicare Coverage, there are deductibles for both Part A (periodical) and Part B (Yearly), also it only pays 20% of Medicare Approved amounts.  This is where a Medicare Supplement or Medigap supplemental Insurance plan comes in.  Call 920-545-4884 for details on how a Medicare Supplement can help cover the Medicare Coverage gaps.  Keep reading for just some of the things Medicare does not cover. 

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Medicare Supplemental Insurance

There are certainly many reasons to consider additional coverage because of the substantial out-of-pocket expenses that will likely become necessary for you to pay over time. These expenses are the direct result of coverage gaps, deductibles, copays, and coinsurance.

If you are considering a Medicare Supplement Plan (Medigap) or a Medicare Advantage Plan, you’ve probably come across various television commercials or online advertisements discussing why these plans may be necessary. 

 

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Medicare Part A and Part B | What's Not Covered

The following services are not covered under Medicare Part A but will likely be needed at some point during your lifetime:

  • Long-Term Care – According to Medicare.gov, Long-term care is defined as “a range of services and support for your personal care needs. Most long-term care isn't medical care, but rather help with basic personal tasks of everyday life, sometimes called activities of daily living.”
  • Dental Care – Medicare Part A doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices. Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you're in a hospital. Part A might cover dental services that are the result from an emergency or complicated dental procedures, even though the dental care isn't covered.
  • Vision Services - Typically, Medicare will not cover eyeglasses or contact lenses. However, if you have to have cataract surgery that implants an intraocular lens, Medicare Part B (Medical Insurance) will help pay for corrective lenses (one pair of eyeglasses or one set of contact lenses).
  • Cosmetic Surgery – Although there is some coverage under Medicare for cosmetic surgery, it is very limited in scope. According to Medicare.gov, “Medicare doesn't cover cosmetic surgery unless it's needed because of accidental injury or to improve the function of a malformed body part. Medicare covers breast prostheses for breast reconstruction if you had a mastectomy because of breast cancer.”
  • Acupuncture – Acupuncture is a type of medical practice that involves stimulating various points on the body, usually with a long thin needle penetrating the skin. Acupuncture is known to quickly alleviate pain and help with the treatment of various health conditions. The practice of acupuncture is not covered under Medicare Part A or Part B.
  • Hearing Exams, Balance Exams, and Hearing Aids – Although Part B does offer coverage for diagnostic hearing and balance exams, the coverage only covers if your healthcare provider orders the test to see if you need medical treatment (usually for some other health issue). Medicare does not cover hearing exams, exams for fitting hearing aids, or the hearing aids themselves.
  • Prescription Drugs – Although Part B provides limited coverage for outpatient prescription drugs under some circumstances, normal drug prescription costs are not covered unless the patient has Medicare Part D which is a stand-alone plan and not part of A or B.  No Medicare Supplement covers prescriptions other than the outpatient drugs covered under Part B.

Note:

Remember that if Medicare Does not cover your procedure at all, chances are that your Medicare Supplement will also not cover the charge.

Medicare Coverage

Medicare Supplemental Insurance coverage is just as the name suggests, it supplements Medicare, or covers the gaps (Medigap).  It will not cover things that are not deemed medically necessary by Medicare. See 2018 Medicare Cost Sheet.

Medicare Supplemental Coverage

Medicare Deductibles, Copayments, and Coinsurance

Other out-of-pocket expenses are the result of deductibles, copayments, and coinsurance that is the responsibility of the patient.

For example, in 2018, Medicare beneficiaries will be responsible for the $183 Part B calendar year deductible, the Part A $1,340 benefit period deductible, plus 20% of all expenses for physician services, outpatient therapy, and durable medical equipment that is considered Medicare Approved.

For most of us who have been paying into Medicare and Social Security for a lifetime, Medicare benefits are a blessing when we reach the age of enrollment. Fortunately, however, we can eliminate almost all out-of-pocket expenses by purchasing very affordable Medicare Supplement Insurance that will pay what Medicare doesn’t pay, and Medicare Advantage Plans that will also pay for some services that are not covered under Medicare Part A or Part B.

For more information about Medicare coverage and costs, and to learn how to fill in the gaps using Medicare Supplement Insurance (Medigap), call the experts on the Medicare Solutions Team at 920-545-4884, or contact us through our website at your convenience.

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