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Coverage Gaps

What does Medicare miss and how do you cover it?

Part A : Hospital Stays 

DEDUCTIBLE & BENEFIT PERIOD
The Part A deductible and benefit periods are different than any other insurance arrangement you’ve had in the past, so we’ll give you the numbers along with some examples.
 

2022 Deductible
$1,556 deductible per benefit period

Benefit Period
The Part A benefit period begins the day you are admitted as an inpatient into the hospital. The benefit period ends when you haven’t received any inpatient hospital care for 60 days in a row.

Copays (2022)
Days 61 – 90 : $389 per day
Days 90 – 150 : $778 per lifetime reserve day

Part A : Skilled Nursing

SPECIFIC REQUIREMENTS
 

The Part A skilled nursing benefit has specific requirements, which we will outline in the video, but here are the copays when you meet the requirements.

Copays (2022)

Days 1 – 20 : $0
Days 21 – 100 : $194.50 per day
Days 101+ : You are responsible for all costs

Part A : Hospital Gaps

HOSPITAL COVERAGE EXAMPLES

 

Part A : Skilled Nursing Gaps

SKILLED NURSING COVERAGE EXAMPLES

PART B : Medical Coverage

DEDUCTIBLE AND OTHER RESPONSIBILITIES
Part B has an annual deductible that is your responsibility. You are also responsible for 20% of the Medicare fee schedule.

Deductible (2022)

$233

Other financial responsibility
20% of the Medicare fee schedule

Limit or Maximum
There is no limit nor maximum to the amount on your 20% responsibility

Part B : Coverage Gaps

MEDICAL COVERAGE GAPS

Part D : Prescription Drugs

COVERAGE GAPS

Part D plans have annual deductibles and as well as copays and coinsurance.

2022 Maximum Deductible  

Up to $480 per year

Other financial responsibility
You are responsible for copays and coinsurance – the specific amounts change based on which phase of coverage you fall within

Limit or Maximum
There is no limit nor is there a maximum out-of-pocket with prescription drug plans

Part D : Coverage Gaps

PRESCRIPTION DRUG COVERAGE EXAMPLES

Other Medicare Gaps

DON’T LET THESE SNEAK UP ON YOU
There are several other gaps in Original Medicare coverage you’ll want to be aware of and protect yourself against.

Dental Services

Dental coverage is not part of Medicare. Luckily, there are several senior dental plans available to help limit your financial risk when it comes to dental coverage.

Routine Vision Care
Vision coverage is not part of Medicare. There are several insurance companies who offer individual vision plans to help alleviate vision care costs.

Glasses & Contacts
Medicare does not cover glasses & contacts.

Hearing Aids
There are some hearing aid discount programs and partnerships to help alleviate these costs.

Long Term Care Expenses
Long Term Care is an incredibly expensive gap in Medicare that is worth taking the time to discuss with a Long Term Care insurance agent. Plans exist to protect you and your estate against the high costs that come with long term care.

Care Outside the U.S.
Need care while traveling outside the U.S.?
Medicare doesn’t cover that.

Excess Doctor Charges
If you receive care from a provider who does not participate with the Medicare fee schedule, any excess doctor charges are your responsibility.

Unapproved Charges
Sorry, but that elective, cosmetic plastic surgery procedure isn’t covered by Medicare. There are other exclusions that do not qualify as Medicare-approved charges and procedures for which you would be responsible to pay. 

Other Medicare Gaps : Video

AND HOW TO FILL THEM


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