What Doesn’t Medicare Cover?

There is a lot of information around about what a Medigap or Supplemental Medicare Insurance policy is and what it covers.  What it does not cover is just as important to you if you are contemplating whether or not you should purchase a supplement.

The 12 Medigap plans cover basic benefits, but each differs depending upon what state you are in.    The twelve plans are labeled A through L, with plan A being the basic policy.  Plan B through L offer the same basic coverage found in plan A, and also offer other additional benefits.  Plans K and L offer similar coverage as plan A, but the cost sharing is different.

None of the standard or basic Medigap plans cover certain benefits, such as long term care for help with bathing, dressing or using the bathroom.  They also do not cover vision, dental care or hearing aids, private duty nursing or prescription drugs.  As mentioned, there are other variations based on the state you are living in and receiving benefits from.

To explore the differences and to look for coverage you can contact your state insurance department, or find The Guide to Health Insurance for People with Medicare: Choosing a Medigap Policy.

Another offering is Medicare Select, which is a type of Medigap policy that often costs less than standard Medigap plans.  That’s the plus part.  The negative is that you can only go to certain participating physicians and hospitals if you need any sort of medical treatment or assistance.  To find out if Medicare Select is available in your state, simply call your state insurance department.

Since Medicare Part A is the most basic plan let’s start there.  Plan A covers your hospital stay up to 60 days.  Starting with day 61, you are responsible for costs through day 150.  Since Medicare doesn’t pay at that point,   All Medigap plans cover days 61 to 150, though you will have to pay the shortfall, as the Medigap plans don’t cover the entire cost during that time.  You will also be responsible for any deductible before Medigap kicks in.

With Part B, you will pay your annual deductible which is $135 in 2008.  Medicare then pays 80% of the doctor and other medical services, 50% of some health services and 100% of some preventative services.

Since Medicare does not pay for all services, as described in the paragraphs above, this is where a Medigap policy takes over.  Plans B through J cover expenses such as the deductible above, skilled nursing home costs, some deductibles for other services,  including at home recovery, preventive care, prescription drugs and foreign travel emergency or urgent care.

As you can see, the expenses that the right Medigap policy covers can offset a lot of out of pocket expenditures.  It is an excellent idea to research this type of coverage so that you  can see how cost-effective the coverage could be and whether it is right for you.  To research the plans more thoroughly you can call Medicare at 1-800-MEDICARE or you can check on the internet at www.aarp.org  and www.cms.gov.  These sites have links to other information, as well.

Whatever you decide to do, research thoroughly, ask questions, calculate the cost of purchasing a Medigap plan vs. the cost in out of pocket expenses if you don’t purchase one.  Get information from your employer, your insurance agent and any other sources on the web.  Another great way to get information is to ask friends what type of insurance they have and how happy they are with the coverage.

They say that people spend more time looking for furniture or buying groceries than they do researching their insurance, yet it is your insurance – especially Medigap – that can literally make them or break  them.  Don’t get caught without protection.  Determine what your needs are and then do your homework.  You’ll be glad that you did.    

One Response to What Doesn’t Medicare Cover?

  • GLENN IRONS says:


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