Six Major Things Medicare does not cover
There are six major things that Medicare does not cover, and in this video I want to go over those six things and try to come up with different solutions to how you can get them covered. When I say that Medicare does not cover these six things, if you look at this chart right here it says, “Sign up for Medicare part A and B.” Medicare A and B cover an incredible amount of Hospital and specialist visits. But the Part A and B card only covers 80%, and it does not cover these six things that I’m going to talk about.
Medicare A and B Cover 80%
If you look to the left, you see Medicare Advantage, and to the right you see Medigap or Medicare Supplement Plans. I’m going to go over which one of these covers these six things, or do both of them cover it, and how you can get them. If we look at this screen, I have up here to the left Advantage Plan and Medigap plans. Medigap can stand for Medicare Supplement Plans, those are the plans that are F, G and N and so forth. Advantage plans are basically private insurance companies, and there’s so many of them that you’d have to know the exact name and number of the plan to dissect it. If we go through this list, the first thing on the list is a drug plan. Now, a lot of advantage plans in 2023 are zero premium plans and they come with a drug plan and they’re called MAPDs, so Medicare Advantage Prescription Drug. They’re zero premium plans, the drug plan does not cost you anything when you get on this plan.
Medicare A and B Cover Zero Drug Plans
When you have original Medicare A and B and you attach a Medigap plan to cover the enormous part a deductible, you’re going to have to get an appreciable stand alone prescription drug plan. If you look at this column here, the drug plan for the Medigap plan can range from $5 all the way up to $100 actually, but generally it’s about $5 to $20 for most people. The $5 plans are usually for people that are taking a cholesterol drug that’s a generic drug or blood pressure or thyroid like levothyroxine, something like that. The drug plans really aren’t that expensive if you’re not taking expensive drugs.
Medicare A and B Cover neither Dental or Hearing
But the original Medicare does not give you a drug plan, and the Medigap plans don’t give you a drug plan either, only the Medicare Advantage plans. Let’s move on to the second thing, that is dental, vision, and hearing, as you see on this column. Now in today’s world, the Advantage plans are attaching a dental, vision, and hearing plan to a lot of their plans. Five or 10 years ago, a lot of the Medicare Advantage plans you had to get the dental, vision, and hearing plans separately. Nowadays, they attach it, it costs you zero. For the Medigap plans, you can get a different company or any plan that you want, but it’s going to cost you usually around $40 to $60 a month. Both of these plans, whether it’s Advantage Plan, dental, vision, and hearing, or if you get it separately, a standalone plan, if you get a Medigap with a standalone dental, vision, and hearing, they’re kind of compatible of what they offer and how much they charge from what I’ve seen.
Medicare A and B Cover Less than an Annual Physical Exam
But, you get one for free and the other one does not come with original Medicare with a Medigap plan. In this video, it kind of sounds like I’m pushing people towards a Medicare Advantage plan, I’m not doing that, I’m just going to go over these six things and then I’m going to give you my opinion on the Advantage plans versus the Medigap plan. Please stick with me. The next thing, number three would be an annual physical exam. A lot of times physicals might be with blood work or without blood work, but with the Medicare Advantage plans, they do give you an annual physical exam. With original Medicare, you do not get a physical exam and you don’t get it with getting a Medigap plan or Medicare Supplement plan either, so that’s a no. Now, these next two are very big because I hear this all the time.
Flex Cards aren’t what Medicare A and B Cover
When people call me, they say… Especially a gym membership, but let’s talk about the Flex Card first. Now with the Flex Card, a lot of Medicare Advantage plans give you a Flex Card where you can spend money at a pharmacy, whether it be CVS or Walgreens or Walmart, Costco, whatever it may be. I actually put up on the screen here, or I will, Aetna’s PDF of their over-the-counter card, which would be their Flex Card, I’m scrolling up. But if you scroll through this, there’s all these different products that they give you money on a Flex Card to spend and get these products. I’m sorry, I have to scroll down. You can pick… If you can see on the screen, you can get allergy medication, I’ll kind of go down here, you can get thermometers, sore throat lozenges, nasal drip mist, you can get all sorts of stuff, cold medicine. They have nighttime flu and cold, all sorts of products with this.
The Flex Cards are very important to people because they can get a lot of free material from their pharmacies and so forth, whereas the Medigap plans do not. Original Medicare does not give out Flex Cards, and from what I’ve seen, the Medicare supplement plans, Medigap plans do not also. That’s another thing original Medicare does not give you.
Gym Membership
One of the biggest things that I hear from people is, “Medicare A and B cover the gym membership correct?” Now, at first I thought to myself, “What’s the big elephantine deal?” You have Planet Fitness, you have Crunch, you have YouFit, and all these different chains that are $10 a month. But a lot of people, when they’re 65 or 70 years old, might go to one of these exclusive gyms, maybe a brand-new YMCA or something else that is $100 a month, I’ve even seen $150 a month.
Yes, you do get Silver Sneakers or Silver and Fit or whatever it may be with a lot of these advantage plans, but original Medicare does not cover gym membership. There’s only a few Medicare supplement companies that do, there’s only a couple. For this Medicare Advantage, that is a big deal for most people, especially when it’s Silver Sneakers by United Healthcare or Accendo Global Fit. You’ll have to look into the Advantage plans in your area and the Medigap plans because some of them do offer gym memberships, and I do have clients that are on those Medicare supplement Plan Gs or Plan Ns that have these gym memberships attached to them.
Long Term Care / Nursing Home Coverage
Now the last thing that Medicare or AKA original Medicare does not cover is long-term care or nursing homes. Now, I’ve talked about this before in many of my other videos, you will get 100 days for skilled nursing, which is basically short-term care if you were to hurt yourself or you need rehab.
If you had a stroke and you had to go into a facility for skilled nursing, you would get 100 days with the Medigap plans and what Medicare A and B cover. For the Medicare Advantage plans, most of the time you would get up to 20 days, and I’m talking about zero. For the Medigap, zero through 100 days would cost you $0. For the Medicare Advantage, zero through 20 would cost you $0 for most of the plans. Once again, you’d have to call my office and ask specifically about your area, what state, and what zip code you’re in. I’m licensed in 46 states, so I have clients all over the country. We deal with Advantage plans and Medicare supplement plans throughout the entire country. Now with this video, a lot of people would say, “It looks like you like the Medicare Advantage more than you like original Medicare with a Medigap plan.”
Medigap vs Medicare Advantage
But, I want to scroll back and I want to go over just a few things when it comes to both of these plans. Now, for the Advantage plan, you see on the premium side that a lot of these, whether they’re HMO or PPO, are zero premium plans. But with the Medigap plans… Now I actually put G here before, but I took it out, so I’ll just put in G because this is what I was talking about. Medigap Plan G, the premium could run you, when you’re a 65-year-old, around $140 a month. Medicare A and B cover your complete hospital stay so you’re going to pay utterly nothing if you have plan f as Medigap coverage. You pay nothing out of pocket for an inpatient, which means hospital stay or anywhere that you stay inpatient. For your doctor or outpatient centers, you’re going to pay the first $226 for the deductible, and then you’re going to pay zero after that.
Medicare A and B cover CAT scans, physical therapy, skilled nursing and ambulance so you’re not going to pay for any of these things with the G plan, once you pay your premium and that $226 for the entire year. Now with the Medicare Advantage plans, a lot of times these plans, if you look at some of these columns like hospitals, will charge $250 a day in the hospital. I’ve seen in New York City, $650 a day in the hospital is what these Advantage plans are charging. Now, a lot of times with the Advantage plans, it’ll be zero to go to your primary care physician and it might be $35 to go see the specialist where with the gap plans, especially the Medigap Plan G, once you pay that 226 for the year, it’s zero when you go to the doctors. You can go to the doctor’s 100 times, specialists, the same thing, it doesn’t matter, it’s not going to cost you anything.
CAT scans will then be zero, MRIs, all that sort of thing. For Advantage plans, a lot of times the CAT scans are 150, $200. I went over the skilled nursing, whereas with the Medigap plan you’ll get 100 days for $0 and with the Advantage plans, you’ll get up to 20 days for most of them at $0. Now, this column right here, MOOP/YR is for the year, that’s maximum out-of-pocket for the year. Now a lot of the Medicare Advantage plans say, “This is the maximum out-of-pocket.” Now, I tried to be conservative on this and put 4,000, a lot of them are $7,550, or if they’re a PPO and you go out of network, it could be $10,000. But for the Medigap Plan G, you know what you’re going to pay per year for inpatient and outpatient care because you’re going to pay your premium. Let’s say your premium is $140, you’re going to pay that each month, you’re going to pay the first $226, and then you’re not going to pay a dime after that for hospital care, doctors, specialists, ambulance, physical therapy, CAT scans, everything, inpatient and outpatient, it’s going to cost you zero because Medicare A and B cover it all.
The max out of pocket over here for the G, if you’re paying $140, is going to be 1,680 for the year. You can’t beat the hospital and doctor coverage with this plan. If the Advantage plan, if the maximum out of pocket is over $7,000, then there’s a possibility you could go all the way up to that. Now, most of the time you would have to have cancer or something like that, but if you had cancer with the Medigap Plan G, you would still only pay 1,680 for all of those visits and everything for the entire year, so you would save money with that plan. In 2023, I’m taking a look at both the Advantage and the Gap plans, and I’m seeing 50% of the people in the country are on Advantage plans and the other 50 are on Gap plans. There are some good things about both of these plans.
Who Told You Medicare A and B cover Vision?
If you call my office and you want to look at Advantage plans and Medigap plans, I can show you all the plans that are in your area as well as what Medicare A and B cover. But the one thing I always tell people, I only do three Medigap plans for all of my clients, that’s Plan G, plan N, and plan high deductible G, unless you’re eligible for Plan F, then I will speak to you about Plan F. But I usually just talk to people about those three Medigap plans, then we go over some Medicare Advantage plans in their area, and they make the decision on which plan is best for them.
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Disclaimer: This video and blog post are for entertainment purposes only. If you want advice on Medicare or any of its plans, please speak to a licensed agent, whether it is me or another licensed agent. No advice should be taken from this video or blog post. If you don’t speak to me about your individual concerns, I can’t give you my 100% opinion. Brian Monahan and Medicare 365 are not responsible for any actions that you take without consulting with a licensed insurance agent.BL Monahan Inc or any of the agents under this agency are not responsible for any changes you make to any insurance plan because of something you read on this site. Once again, this is for entertainment purposes only.
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