Medicare DOES NOT COVER EVERYTHING! | Here are 8 MAJOR Things Medicare DOES NOT Cover

[@Theretirementnerds]

Note on Coverage outside the US: Many (not ALL) supplements have some form of emergency coverage outside the US. There are deductibles and a maximum coverage limit to keep in mind. Advantage plan emergency coverage outside the US is typically (not ALWAYS) handled in a more simple, straightforward way than supplement plans.

[@glennred4830]

Most Countries have no change of cost due to age. Children, adults and seniors all access healthcare without any difference in services or expense. Many Countries have ZERO fees or a small amount for the prescription required. Doctors, Hospitals, Lab tests are all without any invoice in Canada or UK or in NZ or Germany, etc etc. Only the USA creates a profit or greed system for health, water, basic utilities or a birth of a child. Ridiculous process to suppress access to life.

[@joannc147]

VERY helpful! You are well-spoken and every detail is clear. I’ve recently undergone cancer treatment thru a local hospital which provided a “nurse navigator”. I thought that a curious term. Her value was in setting up appts under my Medicare coverage AND phoning to ensure there would be coverage for all treatments including chemo, radiation, lab work and support medical for heart checks, tinnitus work-up and urologist (due to complications). Whew! Thank you for your research. I’ve subscribed!

[@Theretirementnerds]

Aww! Thank you so much! My mom is going through cancer treatment right now as well, so we know the drill. I hope everything is going well for you!

[@joannc147]

@@Theretirementnerds Indeed it has! Great success here ❤

[@pattyeverett2826]

My wife and I are on regular Medicare with a plan G supplement. We also have part D plans. The biggest issue I have with Medicare Advantage(I would call it Medicare Disadvantage) is that an insurance company is taking part of your care for their profits. To me, this is worse than regular Medicare controlling your care. This is the reason for limited networks, endless co-pays, treatment denials(I personally know someone who was denied a treatment by a Medicare Advantage plan), limited number of treatments, pre-approvals and such. One thing you should make clear on your videos is that once you are on Medicare Advantage more than a year, it may be impossible to switch back to regular Medicare with a supplement due to medical underwriting. One other thing, when I was first going on Medicare, I asked my doctors for advice. Every one of them said to choose regular Medicare with a supplement if possible.

[@Theretirementnerds]

Appreciate you watching and adding your perspective. Not sure if you're a subscriber or not, but we do cover these points extensively in several videos on our channel :) If this is the first video from our channel you've come across, welcome!

[@pattyeverett2826]

@@Theretirementnerds This is the first video on your channel that I have came across. I have seen videos from other Medicare advisement channels.

[@Theretirementnerds]

@pattyeverett2826 awesome! Lots of good ones out there, so thanks for taking the time to watch one of ours!

[@amyschaefer1140]

I call it a "disadvantage" plan also. From a case management perspective it's very difficult to get patients the care they need when discharged from the hospital. You have basically handed your care over to a corporation and they deny, deny,deny care. I would never have an advantage plan. 😊

[@Theretirementnerds]

@@MariaLuise1984 thank you for watching. Love the topic idea. One quick note on your comment that will hopefully help a little is knowing how they calculate savings. That $9M savings figure does not mean that they denied or did not order necessary care. Worked at a few healthcare institutions and companies that work on a savings model. The vast majority of savings calculations are coming from avoidance numbers and are usually pretty arbitrary numbers. For example, a group offers a telemedicine service as part of the plan. If someone has a simple case that can be helped via telemed, that telemed service will say, "We saved $XXX.XX because that person didn't go to the ER." That doesn't mean that the person was denied care they deserved, it just means they avoided more expensive care. That was one small example, but these types of avoidance metrics are what are often used to calculate savings, more so that, "Look at how many necessary services we denied." Hope that helps, and appreciate your insights!

[@VeganWithAraygun]

Well laid out presentation! 💯🎯🙏🏻 For each item, thank you for explaining with the right balance between long winded details to overly succinct summarizations.

[@Theretirementnerds]

Appreciate this so much! Thank you 😊

[@artoanoush9239]

Excellent and to the point presentation. My question is the following: does MEDICARE cover yearly physical examinations and blood tests. If not, what is the rout to proceed and have them covered?

[@Theretirementnerds]

Great question. No. Medicare does not cover yearly physical exams or blood tests. Medicare does cover an annual wellness visit - not the same as a physical, and does not have blood work. Here is the resource straight from CMS: www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html

[@dondgc2298]

You missed a major issue. Medicare will not cover the use of any enhanced lens in cataract surgery- which is a shock to most people since they run about $2,500 per eye. So, many Medicare recipients are stuck using monofocal implants because they can’t afford the more modern multi focal lenses.

[@Theretirementnerds]

Thank you for adding this clarification!

[@AS-tt8ui]

Multi-focal lenses make a lot of money for doctors, Mono focal lenses give better long distance, contrast, and low light vision without halos etc. You need readers for reading but mono focal lens still gold standard for the best overall vision.

[@thomascunningham111]

I had cataract surgeries in 2020, both eyes, using the basic lens. The surgeries went well, at age 68. I am very pleased with my basic lens. I still wear glasses, but that's OK. Medicare approves cataract surgery using basic lens.

[@Theretirementnerds]

@@thomascunningham111 eyesight is so precious. In a prior life, we wanted to be an ophthalmologist and were on our way there, so the eyes are fascinating and important. Glad surgery went well and your eyesight is where you need it!

[@Bobrogers99]

@@thomascunningham111When my cataracts were done a few years ago, I paid $2,400 extra to have custom lenses to correct astigmatism. For the first time in my life I now don't need glasses! Medicare pays for an annual exam by my surgeon, which discovered the start of wet macular degeneration. I get the 4 times a year shots for that, which Medicare pays for.

[@robertd9850]

The separate dental plans and Medicare Advantage plans that include dental usually have a limit of $1000 - $3000 per year and don't cover everything. For example, mine covers a crown unless it is purely cosmetic but not the "buildup" the dentist sometimes (always) has to do and that can be a couple hundred dollars.

[@Theretirementnerds]

Thank you for watching and adding these insights!

[@laurafowles2311]

I haven't signed up yet I am 65 still working, I have heath issues it's all very scary, my retirement is SS

[@Theretirementnerds]

Sounds like stating on the company plan is a good thing as long as it isn't too costly for you.

[@doncherf2610]

What about reconstructive surgery if an insured suffered a disfiguring incident such as an accident or necessary cancer procedure to the face for example?

[@freddyhollingsworth5945]

Federal employee here....I'm 17 years from full retirement...Yes, I can keep my health insurance and all, but I wonder if it would be better if I only went on Medicare and bought all the supplements? Also I wonder if the USA will ever have a "single payer" national health "insurance" bx if so, half of my family and coworkers would retire now, they're only working waiting on Medicare at 65... Thanks!!!

[@Theretirementnerds]

Thank you for watching. This could all look totally different in a few years. Federal health benefits for retirees are usually quite strong.

[@Squddle]

Another thing to consider, is that Medicare part A deductible is not like a regular deductible. You might have to pay more than once a year if admitted to the hospital.

[@Theretirementnerds]

Excellent point! Thank you for sharing!

[@pattyeverett2826]

True, but if you can afford a supplement plan, such as part G, this will cover these after the one time per year deductible.

[@masterlee4370]

Excellent video! I looked into an AARP plan in my area. The "G" plan was about $110.00 a month. I was also able to put in my prescription drugs for the "D" plan. With the premium and the drug cost it would run me $900 a year. Right now my work policy with BCBS I pay $0 for my prescriptions. But the medical part of the plan is 60/40 with a $1,500 in network deductible and out of pocket max of $6,350. AARP also looks like they raise rates as a whole and not by age, not a 100% sure. It got me to wondering if maybe they have a huge clientele so they are able to absorb costs better and keep rates lower. I could be wrong. Just wondering what your thoughts are on it. Continued thoughts and prayers for your mom.

[@Theretirementnerds]

Thank you my friend! AARP is massive, so in general (not always) your thought process is on the right track. Larger companies are able to more accurately predict costs and absorb individuals with bad years, and theoretically keep rates more stable. This isn't always the case though. In terms of not increasing with your age, it sounds like you're looking at an issue-age setup rather than an attained-age setup. There are generally 3 different types of arrangements for the supplement plans. Issue-age, attained-age, and community rated. We are going to release a video on that exact topic hopefully Monday or Tuesday of next week :) Thank you so much!

[@Theretirementnerds]

@@MariaLuise1984 Not a lot of people know about this. Excellent point. We always try to educate our clients on specific companies and what to look for, not just when they first enroll into Medicare, but years down the road. Thank you for sharing!

[@josephineford9886]

Good explanation

[@Theretirementnerds]

Thank you!!

[@eduardooramaeddie4006]

Thank you for this important information on Medicare Thank you

[@Theretirementnerds]

Thank you Eddie!

[@eduardooramaeddie4006]

@@Theretirementnerds your welcome

[@MichaelSmith-fp7kd]

Found out the hard way, Medicare does not cover an annual physical, but covers “annual wellness visit”.

[@brendahunter9134]

Thank you for keeping us informed!😊

[@Theretirementnerds]

Thank you for watching!!

[@margieyee6273]

What does it mean when someone chooses Humana Managed Care for their Medicare benefits? Where will I find out what this covers?

[@Theretirementnerds]

Hi Margie, Are you asking about a Humana Advantage plan?

[@zsigzsag]

I've brought this up before but seems to e one of those gray areas. If you have Macular Degeneration and have to have exams periodically say once a year to make sure hasn't progressed to wet MD, would that be covered under Medicare? Seems it would be medically necessary?

[@Theretirementnerds]

Eye care as a result of medical needs are covered. Things like glasses and contacts are not. Hope that helps!

[@dansanders4402]

In order to keep from getting billed into bankruptcy I choose to suffer and stay clear of doctors and hospitals

[@rickarmstrong3944]

I like the nighttime vibe of this video!

[@Theretirementnerds]

Thank you!

[@blujeans9462]

Super basic information - can't imagine too many folks don't know this; but I guess anything is possible.

[@doncherf2610]

Single-payer Medicare For All would cover all dental procedures as well as hearing and vision and mental and nursing home care. We need M4A now!

[@teams3345]

Thanks as always.

[@Theretirementnerds]

Sure do appreciate your support!

[@chuckholz3245]

But if you enter America Illegally, Everything is covered at 100%.

[@michaelb.8953]

Yet you and I have to pay for that also plus our own sh!t. It's expensive being an American and not by our own doing.

[@pattyeverett2826]

BS. Prove this. It my understanding that all people in America(Citizens and non-citizens) only have a basic right to emergency care, nothing else. This is due a to a law signed by Ronald Reagan in the 1980s. My wife worked in health care prior to this, hospitals would send poor patients to hospitals up to 90 miles away instead of treating them. As you can expect, peopled died because of this.

[@chnalvr]

Check your source on that. It is not accurate.

[@pattyeverett2826]

@@chnalvren.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

[@baratono]

More right-wing nonsense.

[@mvmv5883-e3g]

You look like Paul Rudd...

[@Theretirementnerds]

That's a first! Thank you!

[@akita96th]

MY GOD It does take you forever to get to the point. Geeze yak yak yak. I thought I was going to die of old age before you ever got to the 8 things medicare does not cover, dang learn to get to the point.

[@davidfolts5893]

Outstanding content 90 Days From Retirement! Medical necessity is the game's name as defined by Medicare.

[@Theretirementnerds]

Thank you David! Appreciate you watching!

[@Alycanj]

nothing the gov forces on you does anything worth talking about

[@royschultz1377]

Dental is covered in my free supplement(advantage plan?) covers eye exams and glasses and covers part for hearing aids.

[@Theretirementnerds]

Sounds like an Advantage plan if it has those other perks

[@royschultz1377]

@@Theretirementnerds probably. I just go with what my agent suggests

[@pattyeverett2826]

Yes, if you do not mind the limited networks, treatment delays(due to pre-approvals, and even denial of treatment. I personally know someone who is on a Medicare Advantage plan that was denied treatment his doctor asked for.

[@royschultz1377]

@@pattyeverett2826 Never had any problems. You just have to make sure you pick a good provider. Here the best are Essence, Anthem, and United Healthcare

[@neninocencio9325]

Yes, you’re absolutely right! That’s why I switched to Medicare Advantage plan. I learned a lot from your previous videos.

[@Theretirementnerds]

Always love seeing your comments!

[@pattyeverett2826]

If you have had Medicare Advantage for less than a year, I would investigate the problems with it thoroughly before continuing. I personally know someone who is on a Medicare Advantage plan who was denied treatment his doctor asked for. If he was on regular Medicare and the treatment is covered by Medicare, no denial. Once you are on Medicare Advantage more than a year or so, you may be stuck on it forever due to the medical underwriting requirements to get a supplement plan.

[@petemahler4784]

With vision, AARP has eyemed.

[@shelteredsparrow2736]

Definitely helpful. A bit of advice. I bought crutches at Goodwill and keep them for a time when I need crutches. So much cheaper than getting them elsewhere.

[@Theretirementnerds]

Smart!

[@swampholler]

Not all states allow people to be charged excess charges. PA doesn't allow them. (Making Plan N more attractive. )

[@Theretirementnerds]

Correct! Thank you for watching and sharing that!

[@pacmanc8103]

I recently learned that Medicare also doesn’t cover certain blood lab work - lab work that is used to screen for potential health conditions. Medicare denied payment because the lab used a certain procedure code. Of course I as the patient wouldn’t have known that certain tests run on my blood draw wouldn’t be covered - why would I? The same bloodwork was ordered in my last physical 2 years ago (done at the same lab and presumably paid for by my then-insurer). I believe the lab’s billing department used a procedure code with specific modifiers indicating to Medicare that Medicare would likely deny the claim (-GY modifier). The lab invoice is currently under review and my longtime physician (who sees Medicare patients) has been made aware. This all came to my attention only because I have a habit of closely reviewing my quarterly Medicare EOB. Crazy.

[@Theretirementnerds]

It can be tough. Those billing codes become very important and, like we mention in the video, does Medicare consider it necessary...

[@doncherf2610]

"Ear-related medical conditions". Would hearing loss fall into that category?

[@Kelly-ff8lz]

*Promosm* ⭐

[@1aliveandwell]

Any hints for filing appeals for unapproved labs or imaging? I notice the MRI place didnt put all the info the Dr had on the MRI order (maybe they want the cash amount). So many codes, and mention of LCD 37373... It was for pulsitile tinitis (heartbeat in ear sounds). The iron labs werent approved due to codes not listing medical necessity. Am now on 3rd appeal ! You list a good deal of info in your video.

[@Theretirementnerds]

Are you appealing through the provider office, or are you appealing through Medicare?

[@Theretirementnerds]

Send me an email to [e-mail] and we can look at it.

[@1aliveandwell]

Thru Medicare as after calling Dr, they said would send me a copy of Dr notes, which I sent w a letter, MRI order, report... Will email Erik.