Medicare: What's Covered . . . What's Not

With so much talk today about Medicare benefits, this is a good time to clear up some common misconceptions about Medicare coverage. Many people are under the impression that once they sign up for Original Medicare, they are ‘home free.’ They think all their future medical cost will be covered.

Unfortunately, while Original Medicare (Parts A and B) covers many medical and hospital services, coverage is far from 100%. For starters, with Original Medicare, you will have out-of-pocket costs for visits to doctors, medical tests and hospital stays. These will include deductibles, co-payments and co-insurance. 

In addition, Original Medicare does not automatically provide coverage for prescription drugs. Medicare Part D (prescription drug) coverage must be purchased in addition to Original Medicare.

Original Medicare (Parts A and B) does not cover:

· Routine dental exams, most dental care or dentures
· Routine eye exams, eyeglasses or contacts
· Routine foot care
· Hearing aids or exams
· Most care while traveling outside the U.S.
· Custodial care
· Long-term care
· Cosmetic surgery
· Most chiropractic services
· Acupuncture or other alternative treatments

One very important fact is that Original Medicare does not have an annual out-of-pocket maximum or yearly cap on your Medicare expenses. This means there is no limit to how much you may have to spend on your health care in a given year. In contrast, all Medicare Advantage plans have a maximum out-of-pocket spending limit on your Medicare expenses.

There are options that can help keep costs in check. Medicare Supplement Insurance can be added to your Original Medicare. Medicare Supplement Insurance helps with some costs that Medicare doesn’t pay.

A second option is to choose a Medicare Advantage (Part C) plan instead of Original Medicare. Advantage plans are offered by insurance companies who contract with Medicare to provide you with all your Part A and Part B benefits. While Advantage plan benefits vary, many include benefits that go beyond Original Medicare with some providing coverage for prescription drugs as well as routine vision, dental, hearing and foot care. Every plan must have an annual cap on out-of-pocket expenses.

If you would like to learn more about your health insurance options, please call me at 440-255-5700 or plan to attend one of my classes offered at libraries, community programs and colleges throughout N.E. Ohio. You will find a complete list of upcoming classes with registration information on my website at www.mutskoinsurance.com/seminars. 

Laura Mutsko is a licensed insurance broker offering a complete line of health and life insurance products, including Individual, Group and Family Health, Annuities, Long Term Care Insurance, Medicare Advantage, Medicare Supplement Plans, Medicare Part D Prescription Coverage, Vision, Dental and Life Insurance. Mutsko Insurance Services, LLC is located at 6966 Spinach Drive in Mentor, Ohio. Laura can be reached at 440-255-5700 or through email at Lmutsko@mutskoinsurance.com. For more information, visit www.mutskoinsurance.com.