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December 10, 2018

Avoid surprises with Your Medicare Benefits – What’s not covered

health coverageWhen people turn 65 and become eligible for Medicare, they are sometimes surprised to learn that Medicare doesn’t cover all of their healthcare expenses and services.

On average, Medicare covers around 80% of your inpatient and outpatient services. There are also some items which are not covered by Medicare at all.

Learning what Medicare covers ahead of time will certainly help you not to experience any unwelcome surprises. doesn’t cover will help you be better prepared for your enrollment ahead of time.

Items That Medicare Doesn’t Cover

When Medicare was first rolled out in the 1960’s, it was designed to cover hospital services and medical services. There are several things that fall outside of these that are not covered by Medicare at all.

These include routine dental, vision, hearing and foot care. Original Medicare also does not cover cosmetic surgery, most medical care in foreign countries, or long-term care like nursing home or assisted living facility care.

Medicare also did not cover any outpatient prescription drugs for many years. However, in 2006, Congress rolled out a voluntary program to help with outpatient medication expenses called Medicare Part D.

For many years, Medicare didn’t cover preventive care, but in 2010 this was changed and now Medicare offers an annual physical as well as a number of other preventive care procedures.

Fortunately, there are also many individual insurance policies on the private marketplace to help with some of the other items, such as dental, vision and hearing insurance or long-term care insurance.

Covering the Gaps

We mentioned that Medicare covers only about 80% of your medical expenses. You pay the rest in the form of deductibles, coinsurance, and copays.

You can purchase insurance coverage that helps you to pay these expenses when they arise. There are two primary types of additional coverage that you can choose.

You can choose to enroll in a Medigap plan or you can opt to get your Original Medicare benefits through a private insurance program instead, called a Medicare Advantage plan.

Medigap plans are sometimes called Medicare supplements. These plans pay after Medicare first pays its share. The plans help to cover the deductibles, copays, and coinsuranceon your behalf. There are ten standardized plans to choose from in most states, and there are several plan options provide a foreign travel emergency benefit up to $50,000 as well.

You can use your Medigap plan at any Medicare provider nationwide and you never need to get a referral.

Medicare Advantage plans are also called Medicare Part C plans. These private insurance plans typically involve treating with the plan’s network of providers. Typical networks include HMO-style networks where you must choose a primary care doctor or PPO networks where you can see any doctor in the network and even treat outside the network at additional costs.

You will pay copays for various medical services as you go along, and these expectations will be outlined in the plan’s Evidence of Coverage booklet.

Part C Medicare Advantage plans can also build in some extras that Original Medicare doesn’t usually cover, such asdental care, vision exams, and eyeglasses, hearing aids, and even gym memberships. Each plan must cover all of the same medical services as Original Medicare, but how you pay for your share of these services is different. Approximately 30% of Medicare beneficiaries enroll in a Medicare Advantage plan.

Prepare Ahead of Time

Though Medicare isn’t free, you can work with a financial planner or Medicare insurance broker to estimate your costs for Medicare ahead of time. This will help you avoid any unwelcome financial surprises and also help you to fully understand how your coverage will operate.

Danielle Roberts is the co-founder at Boomer Benefits, where she and her team help new Medicare beneficiaries to learn about their coverage and benefits. You can visit her website to learn more about your eligibility for Medicare.

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May 25, 2012

Income Protection Insurance: Should you Get It?

The first quarter of 2012 brought grim news from the Office of National Statistics, which reported an unemployment figure of 2.6 million. A third of this figure is made up of people who have been out of work for a year or more and are therefore classed as long-term unemployed.

With such high levels of unemployment, many workers are considering more seriously the consequences of job loss. In addition to familiarising themselves with their employer’s redundancy terms and looking for areas where they can tighten their belts, many people are investigating income-protection cover as a way of providing some additional security.

What is Income-Protection Cover?

Income-protection cover pays a regular tax-free sum when you experience a loss of income due to illness or injury, with some policies also covering unemployment and redundancy. There are a number of policies available, all offering varying periods and levels of cover.

Points to Consider

It’s important to make sure you understand the full terms and conditions of a policy you are considering taking out to ensure that it is the right fit for your own circumstances. For example, some policies may only pay out for a set period of time, while others may defer payment for a few months after a claim is made.

This delay may be fine if your employer has a generous compensation plan or you have savings, but if your employment contract only covers you for the statutory minimum you may wish to seek out a policy that either pays out right away or backdates payments to the date of a claim.

Similarly, different providers will have different exclusion criteria and rules around how long a policy has to be in effect before a claim could be made. Check if there are any special rules covering self-employment or certain medical conditions in the policy you are considering.

Income protection will pay a regular sum based on a percentage of your total monthly income. This is different to other forms of insurance, such as payment-protection insurance, which only covers the repayment costs of one particular debt or purchase.

If you are made redundant and have payment-protection insurance for your mortgage you would still need to cover the rest of your living expenses either with personal savings or an income-protection policy.

A critical-illness policy will provide you with a tax-free sum if you are diagnosed with a listed illness. However, it does not pay out for every illness in the way that an income protection policy does. Consequently, if illness or health issues are of particular concern to you and your family it may be worth spending some time researching the various income-protection policies available.

Do I Need Income-Protection Cover?

When deciding whether income protection cover is the right choice for you and your family, it may be useful to look into the terms of your employer’s redundancy cover and whether your employer will pay a percentage of your salary if you are off sick indefinitely.

Look at any other insurance policies you may have and make a note of what you would be covered for and how long you would be covered if you lost your job unexpectedly. Are there any gaps and how would you fill these gaps?

Most importantly, take time to consider the various policies available, ensure your chosen policy is right for you and your family and make sure you fully understand the terms and conditions before purchasing any insurance plan.

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