Your job in working with senior clients includes helping them obtain and understand Medicare and Medigap insurance policies. The Medicare handbook gives important insights for you to provide them on costs, coverage, and much of what they can expect from their policies. While they may find it easy to identify the Medicare coverage for services that the policies include, your clients also need guidance on what will not be covered. Helping them understand upfront how their policies do and do not work for certain conditions and services can go a long way toward avoiding conflict and confusion down the road.
1. Eye Exams and Glasses
Most people deal with some kind of vision deterioration at some point in their lives. This can affect your clients' ability to drive, enjoy movies and television, and enjoy many other areas of life that so many take for granted. An aging client base can experience loss of vision quickly, so annual eye exams are critical for them to stay on top of potential problems.
Your clients may be surprised, then, to learn that neither routine eye exams nor glasses and contacts are included in their Medicare coverage. If Medicare policy holders are generally healthy, they will be responsible for all of these costs out of pocket, unless they purchase supplemental coverage that includes these services.
A key word in the handbook, though, is "routine." If someone covered by Medicare receives an eye exam as part of treatment for diabetes, or if that person has been diagnosed as being at high risk for glaucoma, the exam may be covered. At this point, the exam is not routine and is part of the treatment for a specific health condition.
2. Routine Hearing Exams and Hearing Aids
Just as vision loss often comes with growing older, most people experience some kind of hearing loss; however, Medicare coverage excludes routine hearing exams, and does not cover the cost of hearing aids under either Part A or Part B. Your clients may find themselves stuck with a big bill for these services.
Fortunately, you can provide guidance to help here as well. Supplemental insurance plans are available to help with this gap in Medicare coverage. Similarly, some states provide hearing coverage through Medicaid to eligible individuals.
Finally, Medicare does pull in diagnostic hearing exams to check for loss related to a specific illness or injury. Be sure to explain to your clients the difference between a routine exam and a diagnostic exam to help them get the most from their Medicare coverage.
3. Routine Foot Care
Unfortunately, routine foot examinations and care are not included, as trimming nails or caring for corns and callouses falls outside of Medicare coverage. In addition, your clients' policies generally will not cover treatment for flat feet or the cost of orthopedic footwear. All of these tend to be necessary services for an aging population, so they may be surprised to learn that they are not covered.
Again, an exception occurs when your client is under the active care of a physician for health conditions like diabetes or neuropathy due to other health problems. Routine care unconnected to a specific condition, though, is excluded from coverage.
4. Long Term Care
Many individuals who reach old age or suffer debilitating injuries need care beyond treatment for a discrete condition. Long term care, or custodial care, provides assistance for daily tasks like bathing, dressing, and using the bathroom. It can also include help with taking daily medications and other tasks that many of us take for granted now, but may find we need help doing later in life.
Here too, Medicare generally does not cover the cost of long term care. For your clients who want peace of mind for this cost burden, you need to identify supplemental policies and other means of helping them cover this critical service when they need it.
Your role as an independent insurance agent requires you to understand what is covered, what is not covered, and how the policy works to bring these services back into Medicare coverage. The Medicare handbook provides a helpful guide for you; read it carefully and take the time to explain it to your clients based on their individual health concerns.