# Six Health Care Expenses that Traditional Medicare WON'T Cover



## SeaBreeze (Dec 6, 2017)

SOURCE




> Roughly 56 million Americans rely on Medicare to help cover the cost of their doctor visits, hospitalizations and prescription drugs.  But like most forms of health insurance, the program won't cover  everything. The services Medicare won't help pay for often come as a  surprise and can leave people with hefty medical bills.
> 
> Here are six services Medicare doesn't fully cover.
> 
> ...


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## Lethe200 (Dec 10, 2017)

Thanks for posting this. I was aware of all of them, but as you said, so many retirees and potential retirees are not.

I'm always really sad that people - including my own family - ridiculed us for buying long term care insurance when we were in our late 40's. Now we're all in our 60's and early 70's, and they're envious and regretful. Much fear about what might happen to them as they age, but it's too late to do anything except be careful about health and cross one's fingers.


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## Uptosnuff (Dec 10, 2017)

I am surprised about the dental care and hearing aids.  The others not so much.  I have never had insurance coverage for vision care, not even my current insurance.


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## Ruth n Jersey (Dec 10, 2017)

Thanks for the info SeaBreeze. I certainly found out quick enough about the hearing aids. $4000.00 out of pocket for the pair and if you are lucky you might get 4 years out of them. Mine aren't even top of the line. I don't qualify for the implants.


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## Don M. (Dec 10, 2017)

Lethe200 said:


> I'm always really sad that people - including my own family - ridiculed us for buying long term care insurance when we were in our late 40's. Now we're all in our 60's and early 70's, and they're envious and regretful. Much fear about what might happen to them as they age, but it's too late to do anything except be careful about health and cross one's fingers.



It seems that whenever I tried to cut corners on insurance, in the past, something would happen that cost me.  I saw my old parents have to take out a reverse mortgage on their house in order to pay for in home care during their latter years...and they were lucky to have that option, rather than being shuttled off to some mediocre senior center, or having to move in with family.  We pay a bunch for insurance...including LTC...but if we get in bad shape in our later years, at least we will have the resources to get proper care...without screwing up the kids lives.  

Somewhere, along the line, we recognized that we would one day get old, and need to prepare for that day.  It seems that half the people never come to that realization.


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## terry123 (Dec 11, 2017)

My Humana Medicare plan offers a dental policy for $16.00 a month that I bought that pays $1500.00 a year for various things. After I finish my dental work I plan to cancel it for next year.


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## peppermint (Dec 21, 2017)

About the hearing aids....Medicare only covers the testing of your ears...That's it!!!!

I also have Tinnitus and Medicare doesn't cover that, even though it's a medical issue...

I had to get a hearing aid a couple of month's ago....It came to $6000.00 and I still have to go back for the Tinnitus...They say, (which I'm skeptical about) they can put something in the hearing aid to stop the Tinnitus...I will go back after the end of year.....I have to pay for Dental Care after I retired from a School System...I went to an Audiologist...Not one of those Miracle Ears places....


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## Butterfly (Dec 21, 2017)

My Advantage plan pays for one eye exam a year and a percentage toward glasses.  As to dental, I've never had a dental plan that was worth paying for.  The last one I was offered, and which I declined, required you to go to dentists that were WAY more expensive than my  plain ol' dentist that I've used for years and years,  and if I had gone to those more expensive dentists I would have ended up paying more for routine stuff, even with the insurance, than I pay my dear ol' dentist.  Big waste.


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## OneEyedDiva (Dec 26, 2017)

I have Aetna Open Access Medicare via my retiree state benefits and it's been an excellent plan for me. It does cover 120 days of long term care in an approved, skilled nursing facility *per benefit period *(a benefit period starts 61 days after discharge from a nursing home as long as one hasn't gone back in during that time). They do not require a prior hospital stay. Vision is covered for both exam for glasses and my glaucoma specialist who I see every 3 months. Dental is covered only if it's a mandibular surgical issue such as jaw fracture and cancer reconstruction. I had to get a cap on one of my teeth this year. Paid around $2,600 due to an extra procedure that was needed, even though I have an Aetna dental plan (separate entity from the Aetna Medicare). Without it, the cost would have been around $3,500.


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## mathjak107 (Jul 14, 2018)

keep in mind that many advantage plans offer a ppo option to go out of network in emergencies . you can get creamed here in bills if you are not careful .

the big advantage of medicare and a supplement is in an emergency you can go anywhere pretty much and be fully covered  but that is not true with advantage plans that allow out of network coverage .

so as an example:    If you go to a preferred provider, BCBS pays 85% of the doctor's charges and if you go to a non-participating provider, BCBS pays 65%, but that's not the whole story. The preferred providers have already agreed to be reimbursed a certain price from BCBS, but the non-participating providers haven't, so they can charge you anything they want. BCBS will only pay 65% of the UCR (usual, customary, & reasonable) charges. For example, a surgeon or an anesthesiologist charges $2,000, but the contracted price with BCBS knocks it down to $1,000. BCBS pays $850 (85%) and your copayment is $150. However, if the surgeon or anesthesiologist is a non-participating provider and he charges the same $2,000, BCBS will only pay $650, which is 65% of the $1,000 UCR. You are then responsible for paying not only the $350 difference between BCBS's payment and the UCR, but also the other $1,000 that the anesthesiologist billed.

So the bottom line is that your copay with the "in-network" doctor is $150, but you're copay for the out-of-network doctor is $1,350. So you see, just because BCBS will reimburse you for any doctor you see, the amount you have to pay can be quite different.


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## Giantsfan1954 (Jul 29, 2018)

Once again,I'm baffled by this information you provide...
Nursing homes take your social security checks,they allow residents 50.00 monthly for "extras" such as hair dressers,outings etc.
You will be automatically enrolled into medicaid if your SS is insufficient.
Medicare Part A covers inpatient/resident care.
Your bill for the "privilege" of living there covers all necessary meds and treatment.
You are correct about vision,hearing dental being not covered.
If you are "private pay" that's a whole different ballgame.


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## mathjak107 (Jul 29, 2018)

What is there not to understand. The thread is about Medicare and supplements vs advantage plans not nursing home care


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## Giantsfan1954 (Jul 29, 2018)

Were we reading the same post? The first bullet point is long term nursing home care...


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## mathjak107 (Jul 30, 2018)

it is about  Medicare as it relates to nursing homes not Medicaid. Medicare is very limited as to the time and conditions it will pay for . Medicaid in most state leaves the stay at home spouse just about living an impoverished life style .

so the discussion is about Medicare and similar advantage plans , not about going on Medicaid and being nearly impoverished to do so unless you have a long term care partnership plan agreement with your state. The stay at home spouse will be left nearly living an impoverished lifestyle in most states if Medicaid is needed.

the pros and cons of Medicaid is not within the scope of the op’s discussion


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## Giantsfan1954 (Jul 30, 2018)

Im not going to engage in a verbal battle here.
This information this poster is providing is in the first paragraph is incorrect!
In most states and I acknowledge  not all,if there is a surviving spouse  the assets including the home are not attached and thats where Medicaid comes into play.
AARP has long been known as a lobbyist for the healthcare industry and most of their information is incorrect.


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## mathjak107 (Jul 30, 2018)

Giantsfan1954 said:


> Im not going to engage in a verbal battle here.
> This information this poster is providing is in the first paragraph is incorrect!
> In most states and I acknowledge  not all,if there is a surviving spouse  the assets including the home are not attached and thats where Medicaid comes into play.
> AARP has long been known as a lobbyist for the healthcare industry and most of their information is incorrect.



that is only half of the story.


A home can be a protected asset if not in any kind of living trust. However other assets not in a irrevocable trust have no such protection . In many states non probated assets can’t be recovered from so are kind of protected but recovery is after the fact. In order to get medicaid in the first place those assets have to be dealt with up front and spent down.

a home may be a protected asset only when held in personal name. Many screw up here putting the house in some form of living trust where it does not get probated. 

So while it can’t be subject to recovery in most states the delema is that the value of the house now counts towards qualifying for Medicaid. Many times the house has to be sold , the assets spent down for care in order to get Medicaid in the first place.

In order to qualify for Medicaid in the first place the assets  must be spent down to Medicaid’s low limits and the worst part is the stay at home spouse is restricted to what amounts to an income level that allows a lifestyle that approaches in many areas impoverishment.

except for ny ,Florida and ct which  support the right of refusal most states leave the stay at home spouse with very limited resources in order to  have the spouse needing care qualify in the first place.

it rarely is the recovery portion that is the problem , it is the qualifying  issue up front where most of the damage  is done


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## mathjak107 (Jul 31, 2018)

Giantsfan1954 said:


> Im not going to engage in a verbal battle here.
> This information this poster is providing is in the first paragraph is incorrect!
> In most states and I acknowledge  not all,if there is a surviving spouse  the assets including the home are not attached and thats where Medicaid comes into play.
> AARP has long been known as a lobbyist for the healthcare industry and most of their information is incorrect.



for the reasons i listed above  , as it turns out most of the time it is rarely the things we don't know that gets us in trouble , it is always the things we think we know that ain't so .

as i mentioned above recovery by medicaid is rarely an issue . that is because in order to get medicaid in the first place the assets and income have to qualify  and that is where folks get caught up getting hurt .

 many people throw houses in to living trusts to avoid probate  but that comes  back to bite them as the dollars that home is worth now count for the spending down to qualify . the house they hoped to keep that was protected when in their name  now has to be sold and the money spent down just to get medicaid to accept the person going on it .

recovery is rarely an issue according to our elder law attorney because the assets have to be , transferred to irrevocable trusts or disposed of  before look back or  spent down first just to  qualify . unless unreported assets are found or money comes in after the medicaid snap shot recovery is a moot point .


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## Happyflowerlady (Aug 11, 2018)

terry123 said:


> My Humana Medicare plan offers a dental policy for $16.00 a month that I bought that pays $1500.00 a year for various things. After I finish my dental work I plan to cancel it for next year.



My United  Healthcare policy has $2500 for their dental policy each year, plus free cleanings and exams. 
However, My insurance agent just told me today that Humana is upping their benefits and will have new policies out this October that have a lot better benefits and may actually be better than what the UHC is giving right now. 
Once the new policies are out this fall, he is going to compare and see which one offers the best coverage.


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