Central Florida's Independent Jewish Voice

Insights from The Orlando Senior Help Desk What Medicare doesn't cover

A number of people call the Orlando Senior Help Desk at the Jewish Pavilion and ask me whether Medicare will cover their independent, assisted or killed, living and the answer is “no.” They are shocked and often angry.

Most people pay into Medicare through their payroll for all their employment years, thinking that once they turn 65, the coverage will be free. In reality, Medicare has several expenses.

High-income earners pay more in terms of copays, deductibles, and premiums, and expect no out-of-pocket maximum.

Original Medicare covers ophthalmologic costs like cataract surgery. It doesn’t cover contact lenses and glasses or routine eye checkups. Some people may opt to purchase a vision insurance policy, which costs several hundred dollars annually.

Medicare covers any ear-related condition. It does not cover hearing aids or routine check ups, a Medicare Advantage policy may cover hearing aids.

Both the Original Medicare and Medigap plans don’t cover dental procedures like root canals, dentures, or routine checkups. Medicare Advantage may offer dental coverage.

A majority of Medicare Advantage plans in the United States and the Original Medicare don’t cover any medical costs incurred outside the country. Several Medigap plans offer coverage for healthcare costs outside the U.S. Travel insurance policies may provide this coverage, and you may also consider medevac (medical evacuation) insurance.

Medicare doesn’t cover routine foot care like the removal of callus. Medicare Part B covers foot examinations and treatment provided it relates to nerve damage resulting from diabetes. It also covers care for foot ailments and injuries like heel spurs and hammertoe.

Medicare doesn’t cover elective cosmetic surgery. Procedures like tummy tucks and face-lifts aren’t covered, but the plan covers plastic surgery to correct accidental injuries.

Medicare covers limited rehab facility treatments. For instance, if you’ve undergone a hip replacement and thus require inpatient physiotherapy, your coverage will take care of the expenses. But if the condition worsens and needs to be transferred to a nursing home or an assisted living facility, the policy will not cover the custodial costs. 

HMOs and Preventive Medicine-Health Maintenance Organization plans serve patients through a team of healthcare providers that agree to provide members with the services they need. The program covers many preventive health services.

Members must select a PCP (primary care physician) to handle almost all their healthcare needs. Before visiting a specialist, you first have to be referred from your PCP. HMO plans are diverse, but their out-of-pocket healthcare costs are usually lower. You may need to pay a deductible before the beginning of the coverage, and the copayments are also low. It’s may be ideal if you are looking for lower premiums or if you need preventative care coverage.

If your coverage is Medicare Part B, you are free to visit your preferred physician if they accept a Medicare assignment. Medicare Part C, allows you to keep your physician. However, this depends on your particular Medicare Advantage plan and whether your specialist is in the network of providers. 

Choosing a Medicare Supplement That Works for You-While Medicare health insurance may offer great coverage, it still doesn’t cover all healthcare costs. If yours is the Original Medicare Plan and not the Medicare Advantage alternative, you can fill the gaps by acquiring a private supplemental insurance plan. Here are some crucial tips to finding a supplement plan for your healthcare needs:

Analyze the available options — Medicare supplements are standardized and are used in any facility that accepts Medicare payments. You can choose from 10 currently available plans labeled alphabetically from letter A to N.

After identifying the right plan, you’ll proceed to shop, and the price is crucial for this. Talk to an insurance broker. Never fear to seek help from an insurance broker whenever you’re stuck.

Immediately when you turn 65, you’ll be given seven months as the initial enrollment period. The duration comprises three months before you celebrate your birthday, the entire birthday month, and an additional three months afterward. During this period, you’re assured of coverage with no underwritings. Once the time depletes, you can still acquire an appropriate Medicare supplement plan.

Medicare insurance plans are not entirely free, and you may have to pay some extra charges. Furthermore, the policy doesn’t cover every healthcare service. But you can use different approaches to fix the coverage loopholes.

While most seniors face major adjustments when transitioning to an elder-care community, Jewish seniors face additional challenges. Not only do they lose their homes, and many of their friends, but they also lose ties to their cultural heritage. This is where the Jewish Pavilion, a 501c3 non-profit, steps in. The Pavilion serves as a resource that provides room visits, festive holiday celebrations, and more to 450 Jewish residents in fifty facilities for seniors. The Jewish Pavilion promotes inclusion, and thousands of seniors of all faiths are welcomed into our programs. http://www.JewishPavilion.org

The Orlando Senior Help Desk (407-678-9363) helps thousands of callers navigate their way through the daunting senior maze, alleviating caregiver stress while giving advice on all types of elder issues. http://www.OrlandoSeniorHelpDesk.org.


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