Medicare coverage

What sorts of medical expenses are NOT covered by Medicare? I know, a lot of seniors have “supplemental” insurance, implying that there’s a lot Medicare doesn’t cover. So if a person does not have supplemental insurance, what does he have to pay for himself?

Preventive care, although that has changed drastically in the last 5-10 years.

As for not having supplemental insurance, that would require the beneficiary to pay 20% of most approved expenses after their annual deductible has been met. Of course there are lots of exceptions to this but Medicare generally only pays 80% on approved claims.

One of the big things Medicare doesn’t cover is long-term nursing home care. Supplemental policies typically don’t cover that, either. To get that covered, people purchase long-term care insurance.

I agree with **IAmNotSpartcus ** that the big role of supplemental policies is the 20% not paid by Medicare’s 80/20 coverage.

In addition to supplemental coverage, there is another option called Medicare HMOs. Those involve signing your Medicare benefits over to the HMO, and they provide care under their own terms and conditions. Sometimes such plans have been free*. They are generally less expensive than supplemental policies. From what I’ve seen, their main advantage is in terms of covering preventative care that Medicare wouldn’t cover.

  • That is, at no cost above the Medicare premium.

Medicare won’t cover non-emergency* ambulance transfers unless the patient is not capable of traveling by other means. So, if you can get up and walk, medicare won’t pay for an ambulance to take you to dialysis or your doctors appointment. Medicare also won’t pay for a hospital to nursing home transfer if the patient can walk or ride in a wheelchair.
*Any 911 call is automatically an emergency transfer.

Another shortfall is mental health. Instead of paying 80%, Medicare only pays 50% for psychiatric treatment.

When are we going to get out of the dark ages and accept that, say, schizophrenia is as ‘real’ as, say, kidney failure?

There is a search tool at this link where you can check individual items to see if they are covered, and if so, under which Part and how much is covered. For instance, in NJ glaucoma screening is covered 80% once every 12 months if you are at high risk (people with diabetes, a family history of glaucoma, or African-Americans who are age 50 and older), under the Part B benefit, and once you satisfy the $135 deductible for Part B.