What are some examples of expenses that aren't covered under Medicare part A, B, and G?

[pinkpanda11]

I'm not very familiar with Medicare at all. But I know there are some gaps in coverage. What are they?

 

[resjudicata]

@pinkpanda11 I'm going to dump a bunch of links because that'll be easier for a super open ended question:

What Medicare Part A covers

What Medicare Part B covers

What Medicare Part D covers

What Medigap policies cover (Part G for example)

A is for hospital care. B is for physicians. The gap with those specific parts is no prescription coverage which is part D. You can purchase a Medicare Advantage plan (part C) that enhances the base benefits from A and B and also provides D coverage.

 

[pinkpanda11]

@resjudicata Thanks for this. Is there a list of things that aren't covered? That's what I'm looking for. Things like brand name hearing aids, massages, chiro, acupuncture, executive physicals, etc. I have someone who's looking into Medicare but wants to see a list of some exceptions, limitations, or claims that will be denied

 

[possy]

@pinkpanda11 Your friend would benefit talking to a broker or agent in their area.

The govt has minimum requirements for each Medicare part, but each individual carrier administering Medicare might add bonuses. For example 'Best Insurance Ever' might include some dental coverage with their supplement plans but 'Just Ok Insurance' doesn't have any thing above the minimum.

 

[resjudicata]

@pinkpanda11 What does Part A and B not cover

Searchable Medicare coverage

Beyond that I don't know of a resource other than looking at Limitations and Exclusions for specific Medicare parts or Medicare Advantage plans.

 

[lrsenne07]

@pinkpanda11 Acupuncture is not covered by original Medicare. Neither are Jobst stockings. Hearing aids are not covered at all unless you buy a plan with additional hearing coverage. Vision and dental are not covered without purchasing additional coverage.

 

[anishah]

@pinkpanda11 Its usually plan specific.

In my state (FL) the plans with the richest benefits that might cover things like that would be a Medicare Advantage Supplement.

 

[sos2]

@pinkpanda11 In no particular order:

• Medicare A can be exhausted due to long inpatient hospital stays
• Medicare A has a deductible
• Medicare B has coinsurance, neither have OOP maxes.
• Medicare does not cover out of country care

Medicare G covers the above gaps. Remaining ones are drugs (covered under Part D) and nursing homes except for short rehabilitation stays. Part G may have additional benefits that vary widely.

 

[ajharmon89]

@sos2 Part B has a $198 deductible that Plan G does not cover too.

 

[cant_think_of_a_name]

@pinkpanda11 Original Medicare consists of two parts. Part A and part B. G is a supplement. When you have a plan G it pays second to original Medicare. With Plan G you have to pay your part B annual deductible in 2019 it is $185.00. The supplement picks up the rest. (Short East way to explain that)

Part D is for drugs it must be purchased outside of Original Medicare. Sold by private insurance companies just like supplements are.

 

[minyen94]

@pinkpanda11 It won't cover cosmetic procedures.
There are significant limits on physical therapy. Not sure if they pay for chiropractic at all.
Any procedure or drug that Center for Medicare and Medicaid Services (CMS) still deems experimental-that includes some kinds of orthopedic back procedures, some cancer regimens

 

[%D8%A7%D8%B3%D9%88%D9%88]

@pinkpanda11 The way I like to remember it is:
Medicare part A(t) the Hospital
Medicare Part B(efore) the Hospital
Medicare Part D(rugs)

Medicare part A covers you while you’re staying at the Hospital; hospice, skilled nursing(short/long term care) for up to 20 days if you’re accepted (less than 20% of people are covered the first 20 days).

Medicare part B covers you “Before” you stay at the hospital in the form of: doctor visits and surgeries etc.

Medicare Supplements cover the gaps mentioned below:

Gaps in Medicare part A include short term and long term care after 20 days(if you’re even covered the first 20 days), recurring deductible for claim period.

Gaps in Medicare part B include coinsurance and copay of doctor visits, covering your excess charges, covering your visit deductible( annual deductible is no longer covered by any Medicare supplement plans)

I’m not very informed on Medicare part D.

***I recently acquired my AZ life and health insurance license, and only briefly worked at an insurer for 2 weeks, if I have anything wrong or you wish to add on to something, please let me know. I am passionate about insurance and want to understand it as best as I can. I also don’t want to spread misinformation. I’m looking to find work and get licensed in Property and Casualty currently. Please add information that is relevant!

 

[riona]

@pinkpanda11 If memory serves, it won't cover a tubal ligation for purposes of birth control.

 

[austinmiles89]

@riona Because pregnancy is a real concern of septuagenarians...

 

[riona]

@austinmiles89 Or disabled people?

 

[contrecoup]

@riona Yep my boyfriend had to get a vasectomy because I couldn’t get my tubes tied being on Medicare.

 

[phoenixrisinggirl17]

@pinkpanda11 Limited long term care coverage