Now, Medicare A and B covers very well,
but does not cover everything.
So let's look at the details of what A and B will not cover.
Hello and welcome to Medicare School Daily,
where we help you understand Medicare, save money,
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get the most out of your Medicare benefits.
Now today's topic is actually a question.
What does Medicare A and B not cover?
first off, there's some things medically
that A and B will not cover.
Now, really to understand this first bullet
point here of long term custodial care.
You need to understand that Medicare exists
to cover things that are medically necessary,
where there's a high likelihood of recovery.
Well, custodial needs
are not determined to be medically necessary,
but Medicare custodial needs would be such things
as someone needs assistance bathing,
or maybe they have continence issues,
or maybe they need assistance dressing
or they can't feed themselves or the assistance eating.
Maybe they have dementia, Alzheimer's
and they can't be trusted
to take their own medications, or maybe they're in a wheelchair,
and they need assistance getting from the wheelchair
into the bed, or the wheelchair onto the stool
that's called transferring.
And Medicare does not cover those types of things.
Those things are very important.
But Medicare says we're not gonna cover those items. Okay?
They don't determine those to be medically necessary.
So any long term custodial need
is not going to be covered by Medicare.
Now there is insurance products and different agencies
that will cover long term custodial care,
but not Medicare.
All right.
And so that would be something you'd be responsible for.
Now, the second big thing
that Medicare is not going to cover
would be elective cosmetic surgery.
Now, Medicare will cover cosmetic surgery
when it's medically necessary,
meaning maybe someone's been in an accident
or they took a fall and there's been some
kind of an injury and they need some surgery to correct
those injuries.
And so Medicare will pay for that.
But if it's just elective,
which means I look in the mirror
and I don't like my wrinkles or there's something about me
I don't like and I want to have that corrected.
Well, Medicare is not going to cover those items.
You would be responsible for that financially. All right.
So those are the things they're not going to cover.
Now there's
a couple of other items Medicare will not cover,
and that's dental and eye, as well as hearing aids.
Now I'm shooting this video in 2022.
All right. And so I'm going to tell you how it is today as it stands.
As it stands today,
when it comes to dental, there is some proposed
legislation that Medicare is trying to get passed,
but it hasn't passed Congress yet.
And so routine dental means
you would be responsible for your cleanings
and for your fillings in your extractions,
maybe root canals
or crowns or dental implants as it stands today.
Medicare does not cover those types of items.
Now, when it comes to eye, Medicare covers
almost everything, meaning glaucoma and cataracts
and wet macular degeneration,
sometimes people have to have shots in their eyes
for a different issue.
So all of those issues are covered by Medicare.
What Medicare does not cover is preventive eye,
which means someone has
healthy eyes and they just go into the doc and say,
I just want to make sure my eyes are doing well.
That's a preventive eye exam
and you would be responsible for it.
Now, if you're a diabetic, you get two eye exams a year.
If you're having vision problems,
you're seeing floaters or something else is going on.
That's certainly going to be covered
because it's medically necessary
to start with an eye exam.
Medicare would cover that, just not preventive exams.
And Medicare doesn't cover eyewear
unless his glasses after cataract surgery. OK.
And so that would be on you.
And then lastly, hearing AIDS. Now
we believe that Medicare in 2023
is going to start actually covering some hearing aids.
Part of that was in recent legislation.
It looks like that is going to pass.
And so we do believe that in 2023, we may see some benefit
from here for hearing aids within Medicare coverage.
All right.
So these things medically
you need to be aware of because Medicare
is not going to cover them, except that one right there
next year.
All right now, financially, what does it look like?
So we know what's not covered medically,
but financially, how does that impact you?
Well, first off, Medicare, of course, has two parts.
Medicare A and B on the A Side,
which is the inpatient site financially.
Here's what you're responsible for.
Medicare has a deductible.
You remember, a deductible means you pay this
and then Medicare begins to pay.
And so the A deductible in 2022 is $1,556.
So $1,556 would be what it would cost you
to go to the hospital. And that's your
full out-of-pocket for up to a 60 day stay.
Now that deductible is not
annual, it can occur multiple times in the year.
But most people are not going to be in the hospital
more than 60 days.
So up to that 60 day stay, that's all that costs you.
Is your deductible
now if you happen to be in the
hospital longer than 60 days.
Now we're getting into what
we call extended hospital stays.
So month three, month four, month five Medicare
will cover, but now you have a daily co-pay.
And those daily co-pays range from about $380 to about $400
every day, and so extended stays are really costly.
And that would be your out-of-pocket
responsibility for the co-pays if you're in over 60 days.
Again, it's rare,
but that's how they bill it when it occurs.
And then lastly, skilled nursing facilities
are also covered by Medicare A.
Now this is someone.
That's maybe
had a stroke or a hip replacement,
and they need some fairly intensive rehab.
And so they're admitted to the skilled nursing facility
now Medicare says
as long as someone was in the hospital
admitted in the hospital three days or longer
and then they go to skilled nursing,
Medicare will cover everything the first 20 days.
Doesn't cost you a penny.
If you're not in three days
in the hospital before going to skilled
nursing, Medicare won't pay a penny.
But as long as we had a three day stay,
they'll cover everything for the first 20 days.
If you're in longer than that,
then you run into daily co-pays and actually from day
21 to day 100, 80 more days, Medicare will cover you.
But now you're responsible for a daily co-pay. In 2022
that amount is $194.50 a day.
They tell me
the average stay right now is about 30 to 35 days.
So that means
the average person is spending about 10 to 15 days
in the skilled nursing facility
where they're responsible for that co-pay,
which is, you know,
somewhere between two to $3,000 out of their pocket.
All right.
So that's what you're financially responsible for in A.
And then lastly, let's talk about what
your financially responsible for Medicare B.
Remember the
B side of Medicare's pretty much everything
that's going to be outpatient services
and all doctor services.
So we have a B deductible in 2022.
That's $233.
So the first $233 of bills for anything
that's covered by B again, outpatient all doctor services
would be your responsibility.
Medicare won't cover that B deductible
and then after that, Medicare B deductibles met.
Now Medicare's an 80/20 plan.
Medicare pays 80,
but you pay 20%, so you have to pay 20% coinsurance.
So whatever
the doctor bill is or whatever that MRI bill is, anything
related to B services outpatient doctor,
you're responsible for 20%.
And the problem is you're 20% is totally unlimited
and you have that liability and there's no stopping
unless, of course, you get other insurance.
And then lastly, you have 15% excess charges.
Now here's what this means.
That means that there are some doctors
that will add to the Medicare approved amounts.
So let's say a surgeon
has been approved for surgery for $10,000.
Medicare says we believe that's what
that surgery is worth.
That's what we're going to pay at a doctor that
adds excess is going to add $1,500 to that bill.
And whenever excess occurs,
you are now financially responsible for that.
You get insurance to cover where you're going to be
responsible for it out of your pocket.
All right.
So those are the items
that Medicare is not going to cover.
On the B side, you pay the deductible,
20% co-insurance is unlimited
and the excess charges if and when they occur.
These are the things that you're responsible
for medically as well as financially.
Hey, thanks so much for watching the video,
and I do hope that it was helpful.
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