5 Things You Will Need that Medicare Does Not Cover

Medicare Parts A &B are there to help you with curable medical issues, but they will not cover all of the services and materials you will need as you age to live a functional and comfortable life.

This is a small list of things Medicare won't cover, but almost everyone will need each of these 5 things, so this is an important list.

#1 Routine Physicals. Medicare now will cover 1 routine physical within a few months of a person enrolling in Medicare Part B, but that is all. Your doctor will definitely be recommending a yearly physical to you, but Original Medicare will not pay the bill. If you need help paying for a physical, you're going to want to look into Medicare Part C, or a Medicare Advantage Plan/or Supplement. Medicare Advantage plans are everything you need rolled into a neat little package. They cover the hospital, the doctor, and the medicine and involve copays for each type of service. A Medicare Supplement is Original Medicare's little buddy that picks up the slack when Original Medicare falls short. Medicare Supplements do not have copays, and they do not cover medicine. If you need help deciding whether an Advantage plan or a Supplement is right for you, give us a call, because each case is different.

#2 Routine Eye Exams/Glasses. Medicare will pay on medical eye exams, meaning you are diagnosed with something like cataracts, diabetes, glaucoma, or macular degeneration. However, if your eyeballs are perfectly healthy(other than not being able to see the newspaper), then Medicare will not pick up the bill for your eye exam. Medicare will also pay a little towards one pair of glasses following cataract surgery, but they will never cover another pair of glasses, and they pay for very basic glasses post-cataract surgery. Sometimes a Medicare Advantage plan will have coverage for vision, and many times an optometry office will honor a discount that is offered through a Medicare Supplement such as Mutual of Omaha. Other than that, you may need to purchase a separate vision plan to help cover eye exams and glasses. If you need help finding a vision plan, give us a call. We can help you find either a Medicare Advantage plan with vision benefits, or a stand-alone vision plan.


#3 Dental Care. Medicare will help pay for oral surgery if you are in an accident. Medicare will not, however, pay for cleanings or any other dental care. They will not cover dentures under any circumstance. They will not pay to have a tooth pulled. For these kinds of care, you will  need dental insurance. Again, sometimes you can find a Medicare Advantage plan that includes some dental coverage, but most of the time you will have to purchase a separate dental plan to pay for cleanings, fillings, root canals, and dentures. Dental Insurance will help pay for partial and full dentures. If you need help finding a dental plan that meets your needs, give us a call!

#4 Hearing Exams/Hearing Aids. What was that? Oh! Yeah, most of us will get hard of hearing as we age. Have you noticed though how many elderly people can't hear you, but aren't wearing a hearing aid? Medicare may be the culprit. They will not pay for routine hearing checks, hearing aid fittings, or hearing aids. If your doctor recommends that you go for a hearing test and get fitted for hearing aids, Medicare will not help pay for those examinations. Once again, a Medicare Advantage plan may be able to help, and sometimes there are some hearing benefits attached to vision insurance, believe it or not. I do know that VSP, the vision company I do most of my vision insurance with provides some benefits for hearing aids. If you need help finding insurance plans that will help you pay for hearing tests and hearing aids, give us a call.

#5 Custodial Care. Medicare will cover skilled nursing care, meaning either staying in a nursing facility or having a nurse come to your house if you are being treated for a curable problem. They will not pay for someone to come to your house and help you do chores, cook your meals, or help you use the bathroom. Yet that's a lot of what elderly people need help with. As we age and our bodies deteriorate, we need help doing the little things like taking a shower and getting dressed. Medicare will not pay for a home help aid or non medical service staff to help you around your house. These day to day tasks fall under things that Long Term Care insurance would help pay for. Many people expect their children or other relatives to be willing and/or able to assist them as they age. Sometimes this is not reasonable or possible, and it becomes necessary to either hire someone come to the house to help, or to move to a facility that can provide help with normal daily activities. Long Term Care insurance can provide benefits to help manage costs in a variety of circumstances. If you would like to know more about how Long Term Care insurance can help you in the sunset of your life, give us a call!

Medicare is complicated, and can be difficult to understand, even for agents like us! There are lots of nuances, loopholes, and gaps that have to be navigated, and we have the resources and experience to help you. Let us help you prepare for what you will need as you reach 65 and beyond. Call us at 336-342-4438, or send me an email!

Do I need Long Term Care Insurance?

Many people think that they are going to retire, go on Medicare, and that Medicare will take care of all of their healthcare costs from there on out.

FALSE.

Medicare is designed to take care of only one thing: injuries and illnesses that are CURABLE. Well, that cuts out a lot of what many people thought Medicare would cover! The biggest problem that people think Medicare will solve that it in reality doesn't solve is the cost of nursing home care, or home health care. As the country ages, more and more people are moving into nursing homes and finding out that they are very expensive places to live.

Why do people move into nursing homes? Usually it is because they cannot perform certain Activies of Daily Living(ADLs). These activities include bathing, dressing, eating, using the toilet, and transferring(think of moving from a bed to a wheelchair). If someone has trouble doing a few of these activities on their own, they will need a lot of care, and family members are not always able to give the level of care that a deteriorating person needs. On top of not being able to get through normal ADLs, the person may also have health conditions that need to be closely monitored. They may need someone to make sure they are taking their medications and eating the correct diet. Nursing homes are places where all of these needs are provided for. According to Seniorhomes.com, in North Carolina(2015) the minimum daily cost for living in a nursing home is $108, and the maximum is $630 daily.

Medicare will not pay for nursing home care, and neither will any Medicare Advantage or Supplement plan because Medicare benefits are not intended for long term treatment. They are not designed to pay for someone to help you go to the bathroom, cook your meals, or anything that is considered a normal daily activity.

Long Term Care(LTC) Insurance is designed to cover chronic care of a long duration. In North Carolina, LTC policies are required to cover a period of time no shorter than 12 consecutive months of care. The enrollee will determine how long they want the policy to provide care, whether it is 1 year or 3,4, or 5 years. Obviously, the longer the policy provides benefits, the higher the premium. These benefits don't begin until the enrollee begins using the policy. So if you buy a 3 year Long Term Care policy when you are 55, but don't go into a nursing home until you are 75, then your 3 year policy begins the date you enter the nursing home.

Long Term Care insurance will cover more than just your standard nursing home care. LTC will cover many levels of care from Skilled Nursing care when someone is being treated for a disease like cancer, to things like Assisted Living and even Adult Day Care. Adult Day Care is a program that provides care during the day while an elderly person's usual primary care giver(like a son or daughter) is at work, and can be provided in a facility or in the home.

LTC policies usually pay a maximum per day to a nursing care facility, like $80 per day or even up to $300 per day. They also usually have a waiting period that has to be met before coverage begins. Examples of these waiting periods are 20 days, 30 days, 90 days, and can even be as many as 365 days. During these waiting periods, the enrolled member would be responsible for all of the costs of the nursing facility. Again, the longer the waiting period, or the longer you pay for your own care before the policy kicks in, the lower the premium. Many policies include a benefit that waives premiums while the policy is in use, meaning you don't have to pay LTC premiums once you are receiving your benefits.

People are living longer and healthcare is advancing all the time. As healthcare advances and new long term care options are invented, Long Term Care Insurance evolves with it. Long Term Care Insurance means not relying on children or other relatives to pay for all of the costs of caring for someone in their final years of life. Nursing home care can bankrupt someone in a heartbeat, depending on the circumstance. Even at the NC minimum of $108 per day in a nursing home, that totals to $39,420 for a year. Imagine having to rely on your family to pay that bill. Most of us are going to need some level of medical care at the end of our lives, and Long Term Care Insurance is how we prepare.