Medicare Doesn’t Cover the Following:

Did you know that Medicare doesn’t cover many items? See the list below:

  1. Original Medicare doesn’t cover many items such as deductibles and most importantly Original Medicare doesn’t have a maximum out of pocket. It is an 80/20 plan where Medicare pays 80% of what they deem as correct charges while you pay the 20% left. If your Doctor doesn’t take Medicare assignment of benefits, that provider can bill you the 15% that Medicare doesn’t pay.


  1. Prescription medications were not originally covered under Medicare. President Bush signed that bill back in 2008 so there is now drug coverage via a standalone drug plan or through an MAPD plan. There are many options (24 different plans in Nevada) and talking to a broker who specializes in Medicare is a very important step to help you choose the right plan for you.


  1. Deductibles and copays. A hospital stay requires a $1340 payment (or deductible) by you, the Medicare recipient. You can go in and out of the hospital for up to 60 days on that same deductible, then additional daily charges come into play. For days 61-90 you pay $335 per day and after 90 days you pay $670 per day. Please be aware that once you use your reserve days you pay the entire bill going forward. If you get out of the hospital on day 60 and go back in on day 62, the deductible applies again. Pretty expensive! Part B for outpatient services has an annual deductible in 2018 of $183 and once that is paid you are responsible for 20% of the remaining charges. Remember there is no maximum out of pocket.


  1. Long Term Care is not a covered benefit under Medicare. The cost of a stay in such a facility is very expensive so plan ahead by buying LTC insurance. The earlier you buy, the less it costs you.


  1. Most dental and vision care is not covered by Original Medicare. Some MAPD plans do cover basic dental and vision services but as we age, things happen to our teeth and vision and it will mean some out-of-pocket costs to you the Medicare recipient. Of course, there are standalone dental and vision plans but they are expensive and most have waiting periods for major services, eliminating their usefulness. I prefer a dental discount plan what discounts all services and I only pay the discounted amount. No waiting periods or other restrictions apply.


  1. Hearing aids are not a covered expense under Original Medicare. It is somewhat covered under a MAPD plan but the payments are in the low to mid hundreds so you pay most of the cost of the hearing aids.


  1. Lastly, Medicare doesn’t cover medical expenses while overseas. My recommendation is to buy a travel policy whenever you leave the US. One source is on my website There are many different travel options on my site so feel free to visit.


When choosing a Medicare plan to either replace Original Medicare or add a Medicare Supplement or Medigap plan it is advisable to seek the expertise of a Medicare broker. They usually know all the plans in your area and can advise you which plan or plans will suit your situation.

A MAPD plan provides both medical and prescription drug coverage. In Nevada, there are HMO and PPO plans. The HMO follows all the rules of a typical underage HMO, so you can’t go out of network unless there is an emergency. There is no cost for the HMO plans other than your Part B cost of $134 per month (in 2018). The maximum out of pocket runs $1900-$4000 annually depending upon the plan. The PPO plans have a monthly premium ranging from $46 to $130 per month depending upon the plan. These plans offer nationwide coverage and out of network coverage. The maximum out of pocket is around $6700 annually. Both plans have fixed copays and some percentage costs depending upon the service used.

Lastly, there are Medicare Supplements or Medigap policies available. There is a ten plan nationwide, the benefits of each plan is determined by the government and the insurance carrier decides how much they want to charge for their plan. Some of these plans are going away as of 1/1/2020 but those that have those plans can keep them. Be especially careful on which carrier you choose for the plans going away. It could become very costly as time goes on. Let a Medicare broker explain the risks associated with plans that are no longer available.

You also have to buy a separate drug plan because the supplements don’t include drugs.

The Barend Agency Inc.

Len Barend, broker.


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