Medical Services That Medicare Does Not Cover

What does Medicare not cover?

There have been a lot of TV commercials for Medicare supplements. You mention the fact that Medicare does not cover everything, and that some people may want to buy extra coverage. For me, it’s a good idea to find out which common types of health services are not covered by the original plan, decide what you need, and then choose what additional coverage you want to buy. Some of these benefits may be covered by additional health plans, but some may not be covered.

What types of medical services are rarely covered by Medicare? This is not the whole list of things that Original Medicare does not really cover. It is a list of the most common types of health services that many people can accept.

Regular, long-term care is not covered. Irregular or short-term care can be covered. You would have to make other plans to pay for long-term care,.

Common dental services, such as check-ups, fillings and crowns are usually not covered. Medicare offers very limited dental care.

The routine care is usually not covered by the basic plan.

If you plan to travel from the US, you should know that Medicare rarely covers foreign health care. They make some exceptions, but these do not apply to most people who want to travel overseas.

Of course, recipes are usually not included in the baseline. I did not include them in the above list because Medicare beneficiaries can buy RX plans nowadays. Some Medicare Advantage (MA) plans also bundle this coverage.  Enroll and get a quote for 2020 supplements at

Are you bothered about health services not covered by Medicare?

If you want to plan for the cost of nursing care, you need to look for an alternative solution. You can take out long-term care insurance. There are a whole range of state and federal incentives to buy this coverage now. Of course, there are also alternative planning options. Above all, you should only realize that regular, long-term care is expensive, and that it is not covered by your basic Medicare benefits!

If you are concerned about the cost of a visual aid or dental, you can consider a separate policy. If you do not want to spend money for extra coverage, you can also look for help that low-income people may receive from the government or from private organizations. There are several additional county, state, and federal programs that can support qualified residents. Some dental colleges and local foundations can provide additional services for low-income seniors.

Do you intend to travel during your retirement years? If so, you may want to choose a supplement with good travel health insurance overseas. You can also purchase stand-alone coverage for your trips. Just make sure you understand that your basic Medicare benefits rarely cover overseas medical care. Do not count on health insurance if you leave the US. In fact, some Medicare health plans, like MA HMO plans, may only provide in-network coverage in your area. Many of them will cover emergencies, only in the United States.

Part of a good retirement plans is to make sure that you have the health insurance you need.

Medicaid Eligibility Requirements

In order to receive Medicaid, a person who can demonstrate a medical need for long-term care must meet the financial requirements. Medicaid can fund nursing homes, assisted living or home care if the countable resources and income of an applicant do not exceed the modest resource and income limits. Countable revenues and resources are cash and other assets available for food and accommodation. Resources are amounts owned at the beginning of a month while receipts are received during the month. Because Medicaid has few exceptions, revenue that is not taxable income eg, social security contributions, gifts, security deposits, tax-exempt interest, and shared property is generally countable.

An unmarried person can qualify for Medicaid-funded long-term care by reducing countable resources to the applicable resource cap of up to a few thousand dollars. However, Medicaid planning is more complicated for married people because their shared countable resources are taken into account. A joint spouse’s pension (“CSRA”) is intended to protect the spouse from being impoverished at home, but in high-priced states such as New Jersey, Medicaid, which plans to save money, is essential to provide a spouse with a decent standard of living. While the CSRA cap will be adjusted for inflation, it will be $ 109,560 by the spring of 2011.

Because couples usually have to spend almost all of the countable resources beyond the CSRA before Medicaid will pay foster care fees, many people falsely believe that they need to lose everything else if a loved one needs long-term care. However, this only illustrates the risks involved in the implementation of limited knowledge. Since surplus countable resources do not have to be “spent” on long-term care alone, there are many tools to help families save assets.

Medicaid plans to protect savings can be found at

Despite widespread misunderstandings, Medicaid planning does not involve concealing assets, especially as a false Medicaid application is a heinous crime. Instead, they help clients save money by maximizing spouse income pensions and CSRA, turning excess countable resources into tax-free items, spending them fruitfully, and minimizing penalties as gifts are made.


Couples can sometimes raise a CSRA by borrowing (commercially or from loved ones), but the loan must be carefully timed and designed to be effective. Married Medicaid applicants may also receive resources other than uncountable expenses that benefit the spouse of the community. For example, it may be advantageous to upgrade or buy a home or vehicle for the spouse of the community.

Gifts are often a key element of Medicaid planning. While more can be saved by early gifting, Medicaid gift planning can be useful even after entering a nursing home despite the gift-look-back period of sixty-months. However, the 2005 Deficit Reduction Act has significantly changed the Medicaid planning landscape to impose severe penalties if the gifts are not delivered on time. Overpaying or applying for Medicaid too early after giving can unnecessarily trigger years of Medicaid disqualification. For the same reason, excessively small gifts can unnecessarily limit savings. No penalty results from qualifying gift for a disabled person or qualifying gift of a home to a foster child, but as with so many aspects of Medicaid planning, expert advice is essential because the technical options abound.


Is Medigap Insurance The Same As A Medicare Supplement?

For those who are not familiar with Medigap insurance, this is a Medicare supplementary insurance provided by private insurers. This insurance helps individuals pay for some of the healthcare costs that Medicare does not like deductibles, co-insurance, and co-payments. On a vital side note and to avoid any consternation, Medigap supplements and Medicare supplements are the same thing, so it’s important to understand this when you first start exploring the problem.

If you are eligible for Medicare for the first time, you should be relieved and excited that there are credible health insurance that are not expensive. But Medicare is not free and it is your responsibility to cover part of the cost of Medicare services.

To control part of these costs, insurance companies offer additional policies known as Medigap insurance. It is named Medigap because it’s a way to fill some of the Medicare gaps. Some initial confusion is the result of not having an understanding of Medicare gaps. The gaps are not gaps in the services covered, but the expenses which are your responsibility.

A Medigap policy supplements Medicare by paying out part of your expenses. And that’s why Medigap is also known as a Medicare coverage or Medicare supplement.

It is also important to note that Medicare supplement plan G for 2019 is not the same as a Medicare Advantage Plan. Medicare supplements and Medicare Advantage plans are two different types of plans.

The first step in determining the right Medicare plan choice for you is having an understanding how Medigap work. Being familiar with the following facts, you can compare and shop for plans.

There are 10 standardized plans to choose from.

The Medigap Open Enrollment period is the best time to buy. If you have guaranteed emission rights, Medical underwriting is not used. For other times, medical underwriting applies. You will not be subjected to annual registration deadlines. There is no Part D in Medigap plans. Premiums can vary for the same plan from one company to another. Plans can’t be canceled unless the premiums are not paid

With standardization, you can choose a plan that suits your budget. The amount of expenditure in a plan determines the premium. If you are outside the open registry or have no guaranteed emission rights, there are lots other factors that can affect your cost as well. These include: gender, where you reside, age, alcohol and your total health.

The best time to purchase a Medicare supplement plan is during the Open Enrollment period. It begins when you first qualify for Medicare. The enrollment lasts for about 6 months. Within this time, an insurance company must sell to you any of the policies that it offers. It will not keep you waiting for coverage, and will not charge you more due to existing health challenges.

When you start the process of purchasing a Medicare Plan, keep in mind that the terms Medicare Supplement and Medigap Insurance are used interchangeably. Once you’ve overcome all the ambiguity about the definitions, you can start comparing plans and finding your best plan option.

Is The Quality Of Care Improved By Medicare Advantage Plans?

The Medicare Modernization Act of 2003 gave birth to the Medicare Advantage program we know today. These sort of plans allow people and seniors to obtain Medicare for disability from health insurance firms that are privately owned. Insurance firms which offer Medicare Advantage plans must provide benefits which are the same as Medicare Part A and part B. Part A provides cover for the hospital insurance, while Part B covers the health insurance. Apart from covering inpatient and outpatient benefits, Medicare Advantage plans normally cover a few prescription drugs also. Because of this, the plans are sometimes called Medicare Part C. They combine Medicare Part A, B and often Part D coverage.

Ever since MA’s plans become available, they have become a popular alternative to Original Medicare, about 25 percent of all Medicare beneficiaries signed up for Medicare Advantage plans in 2010 alone. From an initial registration of 5.3 million persons the numbers have more than doubled and are still rising every year.

The way has been paved by Medicare Advantage plans for traditional Medicare benefits to be expanded by beneficiaries. Since the inception of the policy, the success of Medicare Advantage among seniors has remained a topic of debate. Of recent, data on the quality of care that MA-registered people received was published.

Medicare Advantage plans offer a higher quality of care

According to a study by the Acting Director of the Policy Department of the Centers for Medicare and Medicaid Services, Niall Brennan and Doctoral Student in Economics at Harvard University, Mark Shepard, MA plans offer better quality care as compared to fee-for-service Medicare plan of Medicare for hospital use and provision of care with widely accepted quality measurements.

When the first data on Medicare Advantage plans became available in 2006, Shepard and Brennan used 11 measurements to investigate the underutilization of effective treatment. Of the 11 measurements, the MA plans in 9 charge activity plans have developed much better than tariff plans. Cost-benefit plans only exceeded Medicare Advantage on a series of measurements that are not as important to overall care.

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A similar study was conducted by the American Health Insurance Plans (AHIP) using Healthcare Effectiveness Data and Information Set (HEDIS) measurements. The study shows quality improvements in health care for MA policyholders with heart disease and diabetes. The results show that diabetic Medicare Advantage policyholders have lesser hospital admissions and fewer stays at hospitals compared to fee-for-service plans. In patients with heart disease, the trend was the same.

MA plans have taken better precautions to prevent unnecessary hospital admissions by using frequent doctor visits and outpatient health services. The feedback is also due to well-planned and better discharge coordination and procedures of medical care services.

According to Kathryn Nix, Policy Analyst at the Heritage Foundation, many comparative studies have shown that Medicare Advantage plans provide above-average medical benefits to their policyholders and better patient outcomes. The excellence of this program has contributed to the popularity of the Medicare Advantage plans.


Information About Medicare Advantageal Insurance Coverage

Many individuals who wish to sign up for Medicare Part B may not understand the important nature of Medicare Advantageal Insurance plans. Even if you’re completely healthy, you’ll never know when a visit to the hospital or the need for extensive diagnostic tests can leave you with thousands of dollars in medical bills. As you might expect, if you currently have chronic conditions like obesity, diabetes, high blood pressure or high cholesterol, the lack of a Medicare advantage plan could easily cost you far beyond you ever thought possible.

Get a 2019 advantage plan here :

No matter how you look at it, increased longevity still strains your body resulting in higher risk of stroke, heart attack, cancer and many other serious illnesses. Considering that Medicare pays only 80% of their contracted healthcare plan, investing in acceptable health care could go well beyond your budget if you do not have complementary Medicare plans to support you. In fact, if you already have some health problems, or know of illnesses that tend to run in your family, obtaining Medicare secondary insurance could easily give you peace of mind, even if you do not need to use the insurance right away.

Although the majority of seniors understand the rewards associated with signing up for Medicare Part B, far too many are not looking for Medicare advantage plans or Medigap insurance. Think about a situation in which you have just retired, and now have Medicare for health insurance, instead of the coverage you had at work. Do you remember when you can just go to the emergency room and pay a copy of $ 50.00? Unfortunately, you would pay a lot more with Part B Medicare. Even if you took only one or two x-rays after an accident, the total cost of the emergency room will be around $ 3,000.

In the event that you did not pay your deductible of $ 110.00, you could pay approximately $ 910.00 with a one-time trip to the hospital. There is no gain saying, if you are diagnosed with a critical medical problem, you can easily spend several thousand dollars in a very short amount of time. In the event that you have worked your whole life to pay off a mortgage loan and have a bit of savings, it would have disappeared in medical expenses, unless you get insurance to advantage your Medicare.

Today, many people are still looking forward to registering for Medicare Advantageal insurance plans for the coming year, as it means they will finally have some kind of safety net when they get sick. While Medicare truly meets the needs of many people, the remainder of the 20% of medical expenses that are allocated to the patient tends to be too costly. If you are disturbed by the extreme rise in the cost of healthcare services, then you owe it to your business to buy Medicare advantage plans to protect your financial future and to guarantee that you will be able to choose the kinds of care you want to get. gives information about the parts of Medicare, what’s new and how to find Medicare facilities, plans, or providers. Medigap Insurance fills the gaps in coverage that your basic Medicare Part A and Part B does not cover.


How to Use Medicaid Planning to Fund Long Term Care

Until recently, most people in need had few alternatives to enter a nursing home and destroy family finances. Today, long-term care can be offered in a variety of settings, and we often help our clients get assets and not impoverish a spouse who stays at home. However, most people in need of long-term care must eventually turn to Medicaid.

When Medicaid first contacted Medicare in 1965, it extended primary care to poor people, especially children. Over the years, the congress has greatly expanded Medicaid and now also funds long-term care in nursing homes, assisted living facilities, private households and other facilities. While all Medicaid applicants must meet very restrictive financial criteria, not every Medicaid beneficiary will be eligible for all benefits as each Medicaid program has its own eligibility criteria.

Because the Medicaid claim rules are Byzantine and complex, it is nearly impossible to carry out effective Medicaid planning without expert guidance. The uninitiated often spends all on home-based care, though senior lawyers can help most people save some of their hard-earned savings and still qualify for Medicaid to fund long-term care.

Although federal regulations set basic standards, states have considerable room to fine-tune available Medicaid benefits and skill requirements. Because Medicaid programs vary from state to state, Medicaid planning should be based on the law of the state in which a person receives long-term care, and Medicaid recipients who change states must qualify again. Hence, Medicaid planning may require significant changes as seniors move from Florida or other states to be closer to their children.

Depending on the extent and nature of the impairment, people in many different environments may receive long-term care. However, most people either go to a nursing home or a supervised hostel or are cared for at home. Fortunately, Medicaid can finance any of these agreements.

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Care options and Medicaid coverage

Nursing homes have a poor general image, probably because of their decidedly institutional appearance. Unfortunately, they are the only option for people who need significant support in many activities of daily life. Assisted living is an intermediate step, comparable to a senior citizen residence with restaurant, activities and local staff. Without a doubt, assisted living offers a nicer finish than nursing homes, but as limited care is available, they will generally not accept people who need significant help. As a professional 24/7 care is extremely expensive, but Medicaid coverage is modest, home care usually only works when provided primarily by the family with paid home health support as supplements.

New Jersey Medicaid pays for long-term care in nursing homes, assisted living facilities and households, but not all states cover the costs in each of these locations. Medicaid is divided into two broad categories: long-term care and other care. Other care includes the usual diagnostics, preventative medicine, surgeries and treatments that we all need from time to time.

Long Term Care Medicaid covers almost all nursing home costs, most of the Assisted Living fees, and some home helps and other expenses that help individuals stay in a private home. All Medicaid applicants must meet financial eligibility requirements, but individuals seeking long-term care Medicaid benefits must also demonstrate that they cannot live on their own.


Medicare Tax 101

A Medicare tax is basically a payroll tax which is applicable to the income earned by you & aids your health insurance after you enroll in a Medicare plan. This tax will be automatically subtracted from your monthly paycheck & will be calculated based on your earnings, which includes tips, wages, some benefits associated with RRTA, as well as self-employment earnings which go beyond a certain limit.


Medicare Tax: Who Pays for it?


Normally, all the employees who’re working in the United States need to pay this tax, irrespective of their status of residency or citizenship. In a few cases, you might need to pay your Medicare tax based on your income outside the country. In case you find that your Medicare tax is withheld from the paycheck, you must get in touch with your company in order to claim to a refund.


The rate of your Medicare tax is decided by IRS & might change from one person to another. For the year 2018, the FICA tax rate is set at 7.65 percent. This includes the Medicare tax of 1.45% percent as well as the Social Security tax of 6.2% percent.


People who’re self-employed might have to pay a higher rate as they’re accountable for paying the share of the employee as well as the portion which your company typically pays.


For more info, you can visit the official site at or get in touch with the Social Security to know the latest tax rate on self-employment by calling their customer help desk.

Enroll in a 2019 supplement plan @

Additional Medicare Tax:


All kinds of wages which presently come under Medicare tax might also come under Additional Medicare Tax. A person owes this tax on compensation, self-employment earnings & cumulative wages each time the final amount surpasses the filing status threshold.


Additional Medicare Tax: Who pays for it?


People must pay this tax if their individual salaries,  self-employment earnings (combined remuneration if married & filing a joint return) and compensation surpass the below max amounts:


Married & filing separately ->> $125k

Married & filing jointly) ->> $250k

Medicare & Nursing Care: An Overview

Generally speaking, Medicare does cover skilled nursing care if it is for a short term. However, it comes with several limitations.


A person might be eligible for Nursing coverage under Medicare if he/she fulfills the below criteria:


Is enrolled in Part A Medicare

Has inpatient stay for 3 consecutive days least, counting the inpatient-admission day to a hospital, however not counting discharge date, prior to taking the nursing home care.

Selects a nursing home that’s approved by Medicare.

Begins his/her stay inside 30 days after being discharged from qualifying 3-day stay in the hospital.

Requires the services regularly (Exceptions below).

The service is supervised/offered by the right person.

The person’s physician has ordered skilled nursing care on his/her behalf.


The person requires the service for either one of the things below:


  1. a hospital-associated disorder which was treated while the 3-day qualifying hospital stay was one


  1. a condition was aroused in a nursing facility while the person was treated there for the hospital-associated condition


Special Case: If a person is in a nursing facility for rehabilitation purposes instead of a skilled-nursing-care, then the requirement for ‘daily basis”  can be more flexible.


So, if a person is getting a treatment (like occupational treatment) just a couple of times per week, then it will be counted as a daily care by Medicare if the person has the therapy each time it is offered to them. If the person refuses it, Medicare won’t compensate for their stay in the nursing home.


Nursing home-care services that are covered under Medicare:


As long as you meet the requirements, Part A Medicare includes:



Physical, speech or occupational therapy

Some prescription medications

Medical supplies, social services, and equipment

Ambulance transport to essential services

Nutrition therapy (for people with kidney disorder)


The above are just a few examples of the services covered by Medicare.


Things That Are Not Covered:


Part A & B Medicare won’t pay for:


Private rooms

Services offered by a facility which isn’t originally approved by Medicare

Custodial care like help bathing or bathing), in case it’s the only care required by a person

Your nursing home costs in 2018:

Medicare normally pays the entire amount for the initial twenty days of your covered nursing home-care.

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During Day 21 to Day 100: Co-insurance of $167.50/day of every benefit period. The enrollee will pay the co-insurance for every additional day during the benefit period.


If a person stays in the skilled nursing care for over 100 days during each benefit term, Medicare will discontinue the coverage for his/her nursing home service. (The period of benefit will terminate when a person does not receive any in-patient hospital care. This also includes nursing care, for two months in a row.)


A few Medicare Supplement Plans can pay for your nursing home service. Even if the care is covered by your Medicare plan, there will be still a certain cost which you’ll need to pay. A supplemental plan might help you cover up these costs.


Does Medicare Supplement Plan Cover Silver Sneakers?

Although each of the Medicare Supplement Plan is standardized, you can find a few insurance agencies offering Silver Sneaker program to assist seniors to enhance their overall health. If you are a senior above the age of 65, you may want to take a look at this program prior to picking a Supplemental plan since not every plan provides Silver Sneakers.


Understanding the Silver Sneaker Program:


This is basically a discounted or free membership to gyms for over 65 seniors. It can work at a private gym, for example, the YMCA or Golds Gym. The participation of a gym in this program may vary from one county to the other. However, you must note that only a few Medigap plans may offer coverage for this program.

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This program can benefit you both physically and emotionally. Physically, it can help you lower your blood pressure and bad cholesterol levels, and reduce diabetes side effects. Plus, you are likely to feel more energetic simply by walking half an hour on a regular basis. Talking of mental health, it can help lower the depression, and also make a senior feel less lonely since they will be able to meet like-minded individuals. This can help enhance their health tremendously.

Is your Gym too far? Not to worry.


Silver Steps program assists senior citizens who reside 24km or further from the gym. Since the program is personalized, you’ll be provided with a kit containing resistance belts, exercise video & how-to DVDs. Thus, nothing will be left out even if you reside in an area that’s far away from the city. Under this program, you are also offered an online component that assists your streaming workouts, nutrition & a forum for communicating with other members.


To conclude, even though most Medigap plans don’t offer coverage for Silver Sneakers Program, you can use the web to know if any such plan is available in your locality.