Medicare – the gaps in US Medicare coverage

One of the suggestions floating around Washington is to open up Medicare to everyone who doesn’t have affordable health insurance – or who can’t buy health insurance because of pre-existing conditions. Fine – what do we younger folk really know about Medicare and what does Medicare cover and where are the “gaps”?

Those lucky retired (65 and over) folks have Medicare; they have nothing to worry about. That is the myth, the truth is much different.

Anyone with parents on Medicare probably already knows the dirty secret – that supplemental insurance is a nice (necessary) cushion for elders on Medicare. Also if your spouse is older than you are and at 65 signs up for Medicare, you don’t get Medicare until you are 65. Medicare also doesn’t cover you if you are traveling overseas or you live overseas. You can buy travel insurance and other expat related insurance which can cover your travel expenses to get you to a US hospital, either returning to the US or in one of the US territories.

Medicare GAPS (The list below was taken from Medicare rights at the link above.)

Some of these gaps in Medicare coverage listed on the website: Medicare Rights were rather surprising.  I’m also curious what the gap list of other countries looks like.

Here’s the list of gaps – or health care costs which are paid for by retirees, or their supplemental insurance plans. Most of these Medicare supplemental plans have a large deductible and a life time limit.

Vision – exams and eye glasses are not covered.

Transportation to and from doctors’ offices or to the hospital – not covered. (Ambulance for emergency is covered.)

Dental Care and hearing aids – not covered.

Long term care isn’t covered (with some exceptions).

Cosmetic surgery – Joan Rivers pays for her own plastic surgery – no wonder she works so hard.

Routine physicals and tests NOT COVERED – if done on a yearly basis these can be expensive. The theory is that physicals can catch problems while they are still small enough to be treatable. This gap is surprising.

Alternative medicine which includes those considered “experimental” procedures and treatment. Acupuncture and chiropractic care is also not covered.

Medical care OUTSIDE of the US is not covered.


Medicare Part D –GW  Bush’s gift that keeps on giving.

Is medicine covered by Medicare? Yes and NO or maybe so. (Only in American or other third world country can medical care for retired people be so confusing and user unfriendly.)

Medicine is covered under Medicare part D. This little gift to the pharmaceutical industry happened during GW Bush’s reign. There are hundreds if not thousands of insurance companies selling Medicare part D insurance. It should be obvious that when so many companies exist – that a whole new layer of middle men are making a profit. Part of GW Bush’s gift to the Insurance companies was — no negations for price reductions on medication were allowed. So thoughtful of the Republicans – the democrats are doing their best to match the GOP in give financial aid to the poor struggling pharmaceutical and the Health care industry. The US Border Guards especially love to hassle senior citizens returning from Canada — they demand to know if anyone visited a Pharmacy while in Canada, and if so what they bought. When I witnessed this behavior from US Border Guards I wondered if they were really working for the Pharmaceutical Industry? It was so East German of them (pre-fall of the Berlin Wall.)

One of the positive elements of that Health care bill was that the doughnut hole in Medicare part D was supposed to be closed.


Medical care received outside of the US (mentioned above).

Medical care received outside of the US is NOT covered.

Let’s take a look at that gap from two directions. Sometimes treatment is less expensive outside of the US. I’ve read about some Insurance companies sending patients to India for surgery. In the UK some citizens choose to travel to India for surgery, and there is debate within the UK government about sending some patients to India as a cost saving measure.

Then for the American expats living overseas, some find it cheaper to use the medical services where they are living. For instance I have a friend living on a Caribbean Island, who needed delicate surgery on her spine. She opted to travel to a specialist on a neighboring island for the surgery. When considering all the gaps in Medicare and what she would end up paying out of pocket in the US – it was cheaper to have the surgery in the Caribbean. Another expat I know was injured and he had Medicare, but with the added advantage of being a military Veteran, he was able to be admitted to the US Veteran’s hospital in Puerto Rico.

Expats living overseas can purchase Emergency medical evacuation Insurance so that they can be flown to the nearest US facility. Another friend living in the Caribbean fell and broke her hip. She was evacuated to the US Virgin Islands for hip replacement surgery. My friend is the only person I know who has actually needed this insurance, but a significant number of expats pay the yearly premiums. After my friend’s good experience with this company – expats living on island, quickly enrolled with this company. This would be useful for expats enrolled in Medicare who must return to the US for emergency treatment.

Canada differs in that they do cover some medical expenses for expats. Canadians must live in Canada for 6 months of the year to maintain their National Health Care coverage. Americans can remain outside of the US full time, but any Medicare covered treatment must be done in the US or US territories. Americans expats also must be enrolled in Medicare. Many American expats opt out of Medicare, finding the cost more expensive than if they seek medical care in country.

Now I’m wondering about the gaps in Medicare and if other countries also have similar gaps in their health care plans for retired pensioners. (In the US pensions are going out of style and for the younger generations the only retirement income they will have is Social Security, or whatever they are able to save. If this is left to Congress and the Health Care Insurance companies — saving for retirement may not be possible for most Americans.)

This article is part of a series. As I research Medicare I will post what I discover to this blog.


One Response

  1. i was starting to consider i may end up being the only lady whom thought about this, at the very least at this point i understand im not outlandish 🙂 i’ll make it a point to have a look at some different posts when i get a little caffeine in me, it can be very difficult to read with out my coffee, I was unbelivably late last night grinding facebook poker and after downing a few ales i finished up melting away all my zynga poker chips adios for now 🙂

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