Understanding Original Medicare
Laying a Solid Foundation | Lesson 5

What Does Original Medicare NOT Cover?

Original Medicare provides a solid base coverage to reduce out-of-pocket costs on the services we’ve talked about in the past few lessons.

But there is much that Medicare doesn’t cover at all.

Now you might be wondering, why are we focusing a whole lesson on this topic?

Well, knowing the ins and outs of these products is essential to helping your clients choose their coverage.

When you understand what Original Medicare doesn’t cover, that opens up the door to cross-sales and coverage alternatives.

What isn’t covered by Original Medicare can usually be picked up elsewhere in another type of plan.

Medicare Part D covers prescription drugs and is offered by private insurance companies.

Part D prescription drug plans, or PDPs as we often call them, typically pair with Original Medicare, and can be sold by insurance agents.

Medicare Supplement plans, also called Medigap plans, serve to fill the gaps in Original Medicare coverage.

These plans are offered by private insurance companies and can be sold by insurance agents.

Alternatively, Medicare Advantage plans, formally known as Medicare Part C, replace Original Medicare coverage by providing both Part A and Part B coverage, while also providing additional benefits, like drug, routine dental, and vision coverage depending on the plan.

These plans are also offered by private insurance companies and sold by insurance agents.

And then last but not least, ancillary coverage, which here at Ritter, we refer to as More Than Medicare.

These are the insurance plans that cover needs outside of Medicare, like dental, vision, and hearing, hospital indemnity, critical illness, and more.

We’ll get into all of those products in more detail in future lessons and modules here on Knight School, but for now, let’s bring it back to Original Medicare.

Here’s a list of just some of the services and equipment not covered by Original Medicare:

Long-term care, most dental care, eye exams for prescription glasses, dentures, cosmetic surgery, acupuncture, hearing aids and exams, even routine foot care, to name a few.

We recognize many of these services as essential, but many of them are especially important to the overall health of seniors.

Dental, vision, and hearing coverage is the best example of something that can be provided by going with a Medicare Advantage plan rather than Original Medicare.

But what if your client has Original Medicare with a Medicare Supplement?

In that case, consider offering individual dental and vision plans to fill that gap.

Long-term care also presents an important need for seniors that is not met by Original Medicare.

While you won’t find coverage for long-term care in Medicare Supplement or Medicare Advantage, there are Long-Term Care insurance plans that help address that need.

And again, we are focusing on Original Medicare in this lesson, but I would be remiss if I didn’t mention, Ritter also offers training and assistance with setting your clients up for Long-Term Care plans.

Our team is always just a phone call away, so if you have questions, please reach out, we’d be happy to help.

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