8 Things Medicare Doesn’t Cover

 You’ll need to plan ahead to pay for some common medical expenses

GETTY IMAGES

Medicare covers the majority of older Americans’ health care needs, from hospital care and doctor visits to lab tests and prescription drugs. Here are some needs that aren’t a part of the program — and how you might pay for them.    

1. Opticians and eye exams

While original Medicare does cover opthalmologic expenses such as cataract surgery, it doesn’t cover routine eye exams, glasses or contact lenses. Nor do any Medigap plans, the supplemental insurance that is available from private insurers to augment Medicare coverage. Some Medicare Advantage plans cover routine vision care and glasses.

Solution: For some people, it makes sense to buy a vision insurance policy for a few hundred dollars a year to defray the costs of glasses or contact lenses. Contact me at GregNinkeAgency.com or 605.868.8330 or 480.400.9837 for a review of all the Eye and Dental options available to you!

 

2. Hearing aids

Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids. 

Solution: If you are in a Medicare Advantage plan, check your policy to see if it covers hearing-related needs. If it doesn’t, or if you have original Medicare, consider buying insurance or a membership in a discount plan that helps cover the cost of such hearing devices. Also, some programs help people with lower incomes to get needed hearing support. Or you can pay as you go. Congress passed legislation in 2017 that allows some hearing aids to be sold over the counter without a prescription. The Food and Drug Administration has until August to issue proposed guidelines for the sale of these devices.

3. Dental work

Original Medicare and Medigap policies do not cover dental care such as routine checkups or big-ticket items, including dentures and root canals.

Solution: Some Medicare Advantage plans offer dental coverage. If yours does not, or if you opt for original Medicare, consider buying an individual dental insurance plan or a dental discount plan. Some have no waiting periods, some do. Contact me at GregNinkeAgency.com or 605.868.8330 or 480.400.9837 for a review of all the Eye and Dental options available to you!

4. Overseas care

Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs incurred outside the U.S. 

Solution: Some Medigap policies cover certain overseas medical costs. If you travel frequently, you might want such an option. In addition, some travel insurance policies provide basic health care coverage — so check the fine print. Finally, consider medical evacuation (aka medevac) insurance for your adventures abroad. It’s a low-cost policy that will transport you to a nearby medical facility or back home to the U.S. in case of emergency.  Contact me at GregNinkeAgency.com or 605.868.8330 or 480.400.9837 for a review of Medigap/Supplement or Travel options options available to you! Or visit GeoBlue

5. Podiatry

Routine medical care for feet, such as callus removal, is not covered. Medicare Part B does cover foot exams or treatment if it is related to nerve damage because of diabetes, or care for foot injuries or ailments, such as hammertoe, bunion deformities and heel spurs.

Solution: If you face these costs, you may want to set up a separate savings program for them. 

6. Cosmetic surgery

Medicare doesn’t generally cover elective cosmetic surgery, such as face-lifts or tummy tucks. It will cover plastic surgery in the event of an accidental injury.

Solution: If you face these costs, you also may want to set up a separate savings program for them. 

7. Chiropractic care

Original Medicare does not cover most chiropractic services or the tests that a chiropractor orders, including X-rays. Medicare Part B does pay for one manual manipulation of the spine by a chiropractor or other qualified provider to correct a vertebral subluxation, which is basically a partial dislocation of a spinal vertebra from its normal position. 

Solution: Some Medicare Advantage plans will cover chiropractic services, so check with your plan. Some chiropractors offer payment plans to help you pay for this care.

8. Nursing home care

​Medicare pays for limited stays in rehab facilities — for example, if you have a hip replacement and need inpatient physical therapy for several weeks. But if you become so frail or sick that you must move to an assisted living facility or nursing home, Medicare won’t cover your custodial costs. (Nursing homes average about $90,000 a year for a semiprivate room and more than $100,000 for a private room. Costs vary based on where you live and what facility you choose.)

Solution: Planning for nursing home care is a big issue, with lots of choices and decisions. But for those with limited income and savings, Medicaid might help fill in the gaps. Contact me for information on Long Term Care plans and other creative solutions that may fit your situation at GregNinkeAgency.com or 605.868.8330 or 480.400.9837 for a review of all the Eye and Dental options available to you!

 

I Lost My Job! Should I Do COBRA or ACA?

 I Lost My Job! Should I Do COBRA or ACA, or a Short Term Plan? 

Losing your job comes with many headaches, including a change in health insurance in many cases. COBRA coverage is one option, but so is a plan under the Affordable Care Act (ACA). So how do you know which one to choose? The decision may be easier than you think.

What’s the difference between COBRA and ACA?

It may seem like you’re wading through alphabet soup when you look at these two options. Start by understanding what each one is.

COBRA, or the Consolidated Omnibus Budget Reconciliation Act, allows you to stay on your employer’s group health plan at your own expense, says Tasha Riggs, sales leader for HealthMarkets in Westminster, Colorado. It also covers your spouse and any dependent children if they elect to be on the plan.

The most important thing to know: You’ll pay the full cost of the premiums, including the amount your employer used to pay. You might also pay an additional 2% administrative fee, says Katie Keith, JD, MPH. Keith is an associate research professor at Georgetown University’s Center on Health Insurance Reforms in Washington D.C. who specializes in the Affordable Care Act and private health insurance.

ACA plans, or Affordable Care Act plans, refers to individual health insurance plans that meet the minimum essential coverage and other requirements set by the federal government.

“People often think that there’s a government plan called ‘Obamacare’ or ACA and a separate private market, but there’s not,” Riggs says. “ACA is a law, not a healthcare policy. Every major medical plan has to comply with it.”

Feeling overwhelmed? Let a HealthMarkets licensed insurance agent help you sort through your insurance options. Start online today or call us at (605) 838-8330.

COBRA vs. ACA: How to Decide

Several factors can help you determine whether COBRA or ACA is better for you.

1. Consider the cost. “For most people who just lost their job, COBRA is too expensive,” Riggs says. ACA plans tend to be much cheaper than COBRA rates. “If your adjusted gross income fits the guidelines, you can get a premium subsidy,” she says. How much the subsidy lowers your monthly premium depends on your age, who’s on your tax return and whom you claim, your ZIP code, and adjusted gross income.

2. Check your deductible. When you switch to an ACA plan, your deductible will reset. But if you opt for COBRA, you’ll keep any progress you made toward your annual deductible while you were employed.

“Those deciding between COBRA and ACA coverage will want to consider how much they have already expended toward out-of-pocket costs, whether they expect to need additional care (or, say, have a chronic condition), and the time of year,” Keith says.

For instance, if you’re close to the end of the calendar or plan year, it might make sense to sign up for COBRA before shifting to ACA coverage. To figure it out, you’ll want to add up the cost of COBRA premiums for the rest of the year against potentially higher out-of-pocket costs with an ACA plan.

If you’ve met your deductible and are close to (or have reached) your out-of-pocket maximum, your remaining COBRA payments might be less than starting a new plan with a brand-new deductible.

3. Think about whether you’re open to switching physicians. “No matter what plan you have, you have to see if your doctor is in network,” says Riggs. Networks change regularly, so it’s important never to assume your doctors will be covered.

If you want to keep your doctors, make sure they accept the new plan you’re choosing. This is especially critical if you have ongoing healthcare needs or chronic conditions and need to maintain access to your providers for continuing care, Keith says.

4. Pay attention to timing. People who lose their job-based coverage generally qualify for a 60-day special enrollment period through the ACA marketplace. That’s true even if you’re offered COBRA, Keith says. That means you have about two months to decide what to do.

However, if you choose to enroll in COBRA, you have to stick with that plan until the policy ends or until the annual ACA Open Enrollment Period, says Keith. You can’t switch to marketplace coverage simply because you want to drop COBRA coverage midyear.

So which should you choose?

The answer, of course, depends on your current situation, which includes everything from your family medical needs to the names on the tax return. The good news? You don’t have to navigate the decision alone. If you need help reviewing your options and finding the right plan, HealthMarkets licensed insurance agents can help at no cost to you. Start online today or call us at (605) 868-8330 or in AZ, NM (480) 400-9837.