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What Does MEDICARE Cover?

What Does MEDICARE Cover?

There are basically 5 items that are not covered by Medicare A & B.

The first three I call the three holes in your head

  • Vision (eye exams and corrective lenses)
  • Dental (exams, cleanings, dentures, bridges, etc)
  • Hearing (exams and hearing aids)
  • Acupuncture
  • Prescriptions Drugs – Covered by Medicare Prescription Drug Plans (PDP’s).

Keep in mind that if a physician is performing diagnostic work, monitoring an existing condition or performing a medically necessary procedure, you are covered.

 

There are a few items relating to elective procedures to enhance or change physical appearance that are not covered.

 

There are a few other rare items out there that are not covered, but they are very few and far between.

 

Everything else is covered but not fully paid and subject to deductibles by Medicare.

Medicare Made Easy

How Does a Plan G work in conjunction with MEDICARE?

Plan G does not cover the Part B of Medicare Deductible (2025 = $257).

After that if it is covered by Medicare but not fully paid by Medicare - it is paid 100%

 

And you get to choose your own doctor.

 

Plan G runs out of benefits if you spend over 500 days in a hospital or more than 100 days in skilled nursing care.  Medicare was never designed to cover those costs.  Long-Term Care Insurance has been created to cover these kinds of costs.

 

Most folks like you choose plan G.

 

If you can afford the premium you should choose to own a Plan G Supplement.

 

NOTE:  Purchasing a supplement and drug plan directly from an insurance company is not going to cost less than purchasing from an agent.  The premium is the same as that with an agent.  Plus with me you get an agent that believes service after the sale is very important!

 

How Does a Plan N compare to a Plan G?

 

Plan N is closer to the coverage you might have under an employer plan or Medicare Advantage Plan.

 

The main difference between Plan N and Plan G is that Plan N does not pay for the excess 15% doctors who do not take Medicare assignment can charge – and – Plan N will have the Part B deductible (2025 = $257) and up to $20 Co-pays for office visits and up to $50 co-pays for Emergency Room visits.

 

A Majority of doctors take Medicare Assignment.  Making Plan N attractive. 

 

If you can afford the Plan G Premium – I would choose a Plan G for peace of mind that you will not have any surprises pop up from doctors not taking Medicare Assignment - even though the probability is very low of such a surprise.  Also, you won’t have any co-pays along the way for office and emergency visits with plan G.

 

It is not unfathomable to have a $50,000 bill these days.  Excess charges could add up - the 15% of that $50K = $7,500!

 

Ask yourself – Do I want to save $15 or $20 per month and have exposure to that kind of surprise?  If YES – you want a plan N – Otherwise you are more conservative like me and would be more comfortable with a plan G.

 

 

If you really break it down – plan N is not going to save you much money at younger ages!

See my 20 minute video explaining Medicare basics.  

Medicare Made Easy Video

 

 

See page 55 of the 2025 Medicare and You for the complete list of non-covered items under Medicare

 

Remember, as your agent - I will review your supplement plan each year and make you aware of the opportunity to lower your rates - if a lower premium plan becomes available.