Welcome to Medicare School Daily, where we help you understand Medicare, save money,
avoid mistakes, and above all else, get the most out of your Medicare benefits. Now, today's
topic is what does Medicare A and B not cover? Which means there are some certain things that
you are going to be out of pocket, 100 percent. Things that Medicare is simply not going to cover,
and those items not covered are actually broken down into two different categories. Number one,
we have some things medically that Medicare is not going to pay, that you would pay 100 percent for.
And then we have some financial obligations, meaning Medicare is going to pay, but you have
some responsibilities as well. So Medicare is not going to cover those things financially. So we’re
gonna look at the medical side of these things that Medicare is not going to cover. First off,
long term custodial care. The keyword here being custodial. Medicare exists to pay for things that
are medically necessary. Custodial care means that someone either because of age or maybe some kind
of physical problem, they're needing substantial assistance with activities of daily living. We
call these bathing or continence or dressing or eating or maybe someone's in a wheelchair and
they need help transferring from the wheelchair to the bed, to the wheelchair to the stool. Those
kinds of things are custodial needs, and Medicare does not cover those items. People that want that
type of custodial care typically get some kind of a long term care insurance type of policy.
Now, there is a time when Medicare could pay for custodial, and that is if someone's in need
of something medically as well. So let's say I have dementia, and I cannot be trusted to take
my medications; maybe I need help bathing, and I have a heart attack. So Medicare is going to
take care of all my heart problems. I may have to have stent implants or surgery or something. And
while those medical needs are being addressed, my custodial needs will also be covered by Medicare.
So that's the time in which they will pay for the studio needs. But as a general rule, when it comes
to long term custodial care, Medicare is not going to pay for those items. Number 2: Medicare is also
not going to pay for routine dental. Now, the only time Medicare is going to pay for dental is
when it's very extreme. Someone has cancer, maybe part of their jaw is removed, and it's medically
necessary to do some reconstruction of the teeth. Medicare will cover that. But other things,
extractions and fillings and root canals and crowns and those types of things, you're going
to have to have some other kind of policy to cover the routine dental because Medicare is not going
to. And then number three, preventive eye. Now Medicare does cover well for eye issues,
glaucoma and cataracts. Sometimes people have to have shots in the eyes,
macular degeneration, those kinds of things.
Medicare covers all that very, very well. But when it comes to preventive, so this is someone
that just wants to go to the eye doctor to see if their eyes are healthy, that will be a preventive
eye exam. You would have to pay for that. All right? Also, when it comes to I wear glasses
and contacts other than after cataract surgery, Medicare does not cover those items as well.
All right? You would be responsible for that or you could get some kind of a vision policy
to cover that. And then cosmetic surgery; so this would be elective cosmetic surgery. Someone would
like to have surgery to correct something. If it's not medically necessary, Medicare's not going to
pay for that. You would be 100 percent responsible for that. And then acupuncture, oftentimes it is
chiropractors that do acupuncture. And so if you happen to go to a chiropractor, the only thing
covered by Medicare in the chiropractor's office would be the adjustment of the spine.
The doctor, of course, has to take Medicare, and the adjustment’s the only thing covered,
so acupuncture, some kind of therapy, maybe even X-rays, those kinds of things are not covered by
Medicare. Only the adjustment of the spine, certainly no acupuncture. And then lastly,
hearing aids. So someone is in need of hearing aids, Medicare A and B is not going to cover
those. You'd be out of pocket or have to have some kind of insurance to cover those items.
All right. So those are things not covered by Medicare A and B, and you would be responsible
for those things. Now, secondly, as we look at things Medicare is not going to cover,
let's talk about the financial part. Now remember, Medicare A and B pays well,
but the only thing they pay 100 percent on would be preventive services. Everything else you're
going to have to participate. So you do have some financial obligations. And remember Medicare is
broken into two parts, A and B. A is inpatient, and B is outpatient. So on the A-side of Medicare,
you're responsible for a deductible. Right now, that's a little over fourteen hundred dollars;
over time, of course, that will go up, but that's what you have to pay to go to the
hospital. Medicare pays everything else, but they're not going to cover your A deductible,
that's on you. And then if someone's in the hospital more than 60 days, Medicare provides
additional coverage for three more months. But you have to pay daily co-pays. Those are extended
care, and they are pretty rare, frankly. But when they occur, they're expensive. So for month three,
we're going to spend well over ten thousand dollars. Month four and month five, we're going
to spend well over twenty-one thousand dollars out of our own pocket. So Medicare pays well, but she
would have to pay co-pays. And then skill nursing. Medicare covers the first 20 days, but after that,
you're going to have a daily copay and that's going to range of about $175 a day up that you
would be responsible for, they'll pay the rest. OK, so that's the A of Medicare. And then lastly,
we have the B of Medicare, which is the outpatient side. Medicare Part B always has a deductible. And
so that's in the two hundred dollar range up, that you would be responsible for once a year. You'd
have to meet the deductible. Medicare pays beyond that. And then remember, Medicare on the B side
pays 80 percent of the bills. You're responsible for 20 percent of the bills. So that would always
be on you. And then there's a possibility of going to a physician that will not take
Medicare-approved amounts as payment in full. And that doctor adds to the bill. And when they add to
the bill, that's 15 percent. You can see that, that's called an excess charge. And when that
happens, you have to pay for it. And so the point is Medicare does pay well, but you still have some
financial responsibilities. And this is the reason why many will buy supplemental plans to take care
of these particular gaps so that they're not liable for all those expenses. So, yes, Medicare
is a great insurance, covers lots of things, and covers very well. But there are some things
that you're going to have to pay for out of your pocket medically as well as these financial gaps.