Medicare Is an Important Foundation. But What About the Potential Gaps in Coverage?

Choosing the right Medicare coverage is an important part of protecting your health and finances as you get older. But Medicare doesn't necessarily cover every healthcare service you may want—or every expense you could encounter. Routine dental care, eye exams and eyewear are examples of services that Original Medicare generally doesn't cover. And even when Medicare covers a hospital stay or other medical care, you may still be responsible for deductibles, copayments, coinsurance or other expenses.

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That's why Gina believes Medicare planning should sometimes involve a broader question: What does your overall healthcare protection look like? At Rogue Valley Insurance Partners, Gina can help you review your Medicare coverage and explore additional insurance options that may help address needs or expenses that your primary Medicare coverage doesn't. The goal isn't to buy insurance simply because it's available. It's to identify the protection that's important to you.

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What Doesn't Original Medicare Cover?

Many people are surprised to discover that Original Medicare doesn't cover certain services they may consider part of routine healthcare. For example, Original Medicare generally doesn't cover most routine dental care, including regular cleanings, fillings, dentures and many other dental services. It also generally doesn't cover routine eye examinations for eyeglasses or contact lenses, and in most situations it doesn't pay for eyeglasses or contacts. Hearing aids and routine hearing examinations for fitting hearing aids also aren't generally covered by Original Medicare.

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There are exceptions when certain services are medically necessary and meet Medicare's coverage requirements. But as a general rule, routine dental, vision and hearing needs deserve separate consideration. Depending on the Medicare coverage you choose, some of these benefits may already be included. If they aren't—or if the included benefits don't meet your needs—separate coverage may be worth exploring.

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Dental Coverage Can Become Increasingly Important

Good dental health doesn't become less important when you turn 65. Regular examinations and preventive care may help identify problems before they become more serious. Crowns, bridges, dentures, periodontal treatment and other dental services can also become significant expenses. Because Original Medicare generally doesn't cover routine dental care, some people choose separate dental insurance to help manage those costs.

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But dental plans aren't all alike. When comparing coverage, you'll want to understand:

• Which preventive services are covered?

• What will I pay for basic and major dental work?

• Is there an annual benefit maximum?

• Is there a waiting period for certain services?

• Can I continue seeing my current dentist?

• Does the plan use a provider network?

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A dental plan that looks inexpensive may not necessarily be the best value if it doesn't fit the type of care you expect to need. That's why it's helpful to look beyond the premium.

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What About Vision Coverage?

Your eyesight can change over time, and routine eye care may become increasingly important. Original Medicare covers certain eye-related services when specific medical conditions or circumstances apply, but routine eye exams for prescribing eyeglasses or contacts generally aren't covered. Separate vision coverage may help with expenses such as routine eye examinations, eyeglass frames, lenses or contact lenses, depending on the plan. Again, the details matter.

 

How frequently can you receive an eye examination? How much does the plan contribute toward frames or lenses? Which optometrists and optical providers participate? Are there limits or allowances you should understand?

 

If you already have vision benefits through a Medicare Advantage plan, Gina can also help you understand what you currently have before you consider purchasing anything additional. Sometimes the first step isn't adding coverage. It's simply understanding the coverage you already have.

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What Is Hospital Indemnity Insurance?

Hospital indemnity insurance works differently from Medicare health coverage. Rather than paying doctors or hospitals according to Medicare's benefit structure, a hospital indemnity policy generally pays a fixed cash benefit when covered events occur, according to the terms of the policy.

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Depending on the policy, benefits may be associated with circumstances such as a covered hospital admission or a specified number of days in the hospital. The money is generally paid to the insured person rather than directly to the healthcare provider. That means the benefit can potentially be used toward expenses that matter to you—whether those are healthcare-related out-of-pocket costs or other household expenses that arise while you're dealing with a hospitalization. Hospital indemnity insurance doesn't replace Medicare. It doesn't replace Medicare Advantage. And it isn't designed to pay every medical bill. Instead, it's supplemental protection that some people choose because they want an additional financial cushion if a covered hospitalization occurs.

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Is Hospital Indemnity Coverage Right for Everyone?

No. And that's an important point. Some people are comfortable with the potential out-of-pocket costs associated with their Medicare coverage and have sufficient savings to manage an unexpected hospitalization. Others prefer the predictability of having additional insurance protection. Your current Medicare coverage, financial situation, health concerns and personal comfort with risk can all influence that decision.

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Rather than starting with: “Do I need hospital indemnity insurance?” Gina can help you start with a better question: “What financial exposure do I currently have, and am I comfortable with it?” Once you understand the answer, you can decide whether additional protection makes sense.

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Don't Pay Twice for Benefits You Already Have

This is particularly important if you're enrolled in Medicare Advantage. Many Medicare Advantage plans offer additional benefits that Original Medicare doesn't cover. Depending on the plan, those may include dental, vision, hearing and other supplemental benefits. Before purchasing separate coverage, find out what your existing plan already provides.

 

Then look at the details. A plan may advertise “dental coverage,” for example, but that doesn't tell you everything about covered services, provider networks, annual limits or your potential costs. The same principle applies to vision and other additional benefits. The objective isn't to accumulate the largest number of insurance policies. It's to create a coverage strategy in which each piece serves a purpose.

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Questions Gina Often Hears

Does Medicare cover dental care? Original Medicare generally doesn't cover routine dental services such as cleanings, fillings and dentures. Certain dental services may be covered in limited circumstances when they're closely connected to the treatment of a Medicare-covered medical condition.

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Does Medicare pay for eyeglasses?
Original Medicare generally doesn't cover routine eye exams for eyeglasses or contacts. Medicare may cover certain vision services under specific medical circumstances and may cover corrective lenses following cataract surgery when Medicare's requirements are met.

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Do Medicare Advantage plans include dental and vision?
Some do. Benefits vary by plan and service area, so it's important to understand exactly what a particular plan offers.

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What does hospital indemnity insurance do?
It generally pays a predetermined cash benefit when a covered hospital-related event occurs, according to the policy terms. It is supplemental insurance rather than a replacement for Medicare.

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Do I need additional coverage if I already have Medicare Advantage?
Maybe—or maybe not. Start by understanding the benefits and potential out-of-pocket expenses in your existing plan. Additional coverage should address a genuine need rather than duplicate protection you already have.

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Look at Your Coverage as a Whole

Medicare decisions don't have to end with choosing Original Medicare or a Medicare Advantage plan. For some people, that Medicare coverage provides exactly the combination of benefits and financial protection they're comfortable with. For others, there may be areas worth exploring further.

• Dental care.

• Vision care.

• Hearing needs.

• Potential expenses associated with hospitalization.

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The important thing is to understand where your coverage begins, where it ends and whether you're comfortable with what happens in between. Gina can help you look at the larger picture. She'll review the coverage you already have, listen to the concerns that matter to you and help you explore additional options when they make sense. No pressure to add coverage you don't need. Just a thoughtful conversation about protecting what's important to you.

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Let's Look for Gaps in Your Coverage

If you're unsure what your Medicare plan covers—or you're concerned about dental, vision, hearing or potential hospital expenses—bring your questions to Gina. Together, you can review the protection you already have and identify areas that may deserve a closer look.

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Call Gina today to schedule a no-obligation coverage review. Because good insurance planning isn't about having more coverage. It's about having the right coverage for you.