What Medicare Doesn’t Pay

You picked your plan. Here is the part nobody walked you through.

Medicare and a good supplement do their job. They pay doctors. They pay hospitals. If you get sick, the medical bills are largely handled, and that is exactly what they were built for.

But a serious diagnosis brings a second set of bills. Those are the ones that arrive at your kitchen table, in your name, and Medicare was never designed to touch them. Nobody hands you a check for the rides to treatment, the help at home, the ramp, the groceries, or the mortgage that is still due on the first.

The gaps are bigger than most people expect

These are the costs that keep showing up in real claims, and the reason our clients call us six months after a diagnosis instead of six months after enrollment:

• Help at home. Medicare puts it plainly on its own site: "Medicare doesn't pay for long-term care." That is bathing, dressing, meals, and getting around safely. About 52% of people turning 65 will need that kind of help at some point. (Medicare.gov; ASPE and the Urban Institute)
• Your deductibles and coinsurance, which land all at once and land hardest if you carry a High Deductible Plan G.
• Getting to treatment. Weeks of chemo, cardiac rehab, or physical therapy, and you are not cleared to drive.
• Changes to the house. A ramp, a stair lift, a walk-in shower, a wider doorway.
• Income. Yours if you are still working, or the family member who cuts back hours to take care of you.
• Everything that keeps running while you recover. The mortgage, the utilities, the groceries, the insurance on the car sitting in the driveway.

Four policies that pay you instead of paying the hospital

Each of these is a separate, simple policy. They are not Medicare, they do not replace any part of Medicare, and they pay you directly on top of whatever else you own.

Why this probably never came up before

Here is our incentive, on the table. The industry gets paid when you enroll in a Medicare plan, and for a lot of people the conversation ends right there. Nothing dishonest about it. It is just that enrollment is where the job is considered done.

We do not think it is done. You can have the right Medigap plan, the right Part D plan, and a perfectly clean enrollment, and still be wide open to the six things listed above. Knowing that is worth something even if you never buy a thing from us.

If you would rather solve it in one move: the HDG Coverage Combo

This is the approach we build most often, and it is the reason we talk about High Deductible Plan G so much.

You take the low premium on the Medigap side with High Deductible Plan G, then use what you are not spending on premium to buy cash coverage for the events that actually wreck a budget: cancer, a hospital stay, a heart attack or a stroke. The Medicare side stays covered. The cash side stops the second set of bills. For a lot of households the whole package costs less per month than a standard Plan G premium on its own.

Or just ask us

Bring us what you already have. We will tell you which of these gaps is actually open for you, which ones are not worth insuring in your situation, and what the honest cost looks like.

Cancer, heart attack and stroke, hospital indemnity, and short term care policies are supplemental insurance products. They are not Medicare, they are not Medicare Supplements, and they do not replace any part of your Medicare coverage. Benefits, covered conditions, waiting periods, exclusions, and issue ages vary by carrier and by state, and all coverage is subject to the terms of the issued policy. Statistics cited from Medicare.gov, the Centers for Disease Control and Prevention, the American Heart Association, the American Cancer Society, and the HHS Office of the Assistant Secretary for Planning and Evaluation with the Urban Institute.