“What? Medicare doesn’t cover that?”
For most of us, Medicare is a godsend…especially if you’ve struggled to find affordable health care.
Unfortunately, Medicare doesn’t cover everything…and you don’t want to be surprised when something isn’t covered.
Here are the most important things traditional Medicare (parts A and B) doesn’t cover, and what you can do (in some cases) to help cover the cost. Plus, we’ll look at what’s different if you choose a Medicare Advantage plan instead of traditional Medicare.
Long-Term Daily Care
Medicare covers hospital stay plus short stays in skilled nursing facilities after a hospital stay. It also covers home visits by a doctor or nurse (if your doctor certifies you’re homebound).
However…Medicare doesn’t cover daily care (like bathing, dressing, cleaning, and cooking) at nursing home, skilled nursing facilities, or in your home.
You can either pay out of pocket (which can cost thousands of dollars per month) or get a long-term care insurance policy.
Dental Care
Routine dental services, like cleanings, fillings, and dentures, aren’t covered by Medicare. However, Medicare may cover dental care that’s part of a medical procedure, like jaw surgery.
Your options? Either purchase a separate dental insurance policy or pay out of pocket for regular checkups and routine dental work.
Vision Care
Medicare will usually cover treatment for specific medical conditions such as cataracts or glaucoma. It won’t cover regular eye exams, glasses, or contact lenses.
If vision care is important, you may want to look at separate vision care insurance. Otherwise, you’ll need to pay out-of-pocket.
Hearing Aids and Exams
Routine hearing exams or hearing aids are also not covered by Medicare. Typically, you’ll have to pay for these yourself.
Prescription Drugs
Prescription drug coverage is one of the biggest holes in traditional Medicare. This can be a major shock to your pocketbook if you’re used to just paying a copayment at the pharmacy under your old insurance.
Medicare part D was added to Medicare in 2006 to help cover prescription drugs. These are administered by private insurance companies but follow Medicare rules.
Premiums and copayments can vary from minimal to expensive, depending on whether your prescriptions are brand name or generic.
Prescription discount programs can also be an option.
Cosmetic Surgery
If you want to do something about your crow’s-feet or get a tummy tuck, you’re on your own. Medicare won’t pay for procedures done purely for appearance.
However…
If you need necessary reconstructive surgery after an injury, Medicare may cover it.
Routine Foot Care
Routine foot care becomes more important as you get older. But Medicare won’t cover it unless you have a condition that requires medical foot care, like diabetes.
Basic foot care like nail trimming or callus removal isn’t covered by Medicare. You’ll have to pay out of pocket for these services.
Alternative Therapies
Almost everyone has a chiropractor, massage therapist, or acupuncturist they swear by.
Unfortunately, traditional Medicare only covers these in limited cases, such as:
- Chiropractic spinal adjustments (if your chiropractor accepts Medicare)
- Acupuncture for chronic lower back pain
If you rely on these treatments and Medicare doesn’t cover them, you’ll need to pay out of pocket. Many providers offer senior discounts or packages.
Medical Care Outside the U.S.
Travel can be one of the best parts of retirement. But if you travel outside the U.S., Medicare generally won’t cover your medical care.
If you plan to travel overseas, you might want to purchase travel health insurance.
What if I Have Medicare Advantage?
In some cases, Medicare Advantage plans can cover some things that traditional Medicare or Medigap plans don’t cover.
These can include:
- Prescription drugs
- Dental
- Vision
- Hearing
- Emergency travel medical care
Premiums, deductibles, and co-payments can vary between Medicare Advantage plans. Plus, not all plans cover the same things, so be sure to check the fine print before you sign up.
What You Can Do
Traditional Medicare covers a lot…but it doesn’t cover everything.
Some of the gaps can be significant, like prescription drugs and dental, vision, and hearing care.Others, like daily care, can have a big impact if you are homebound or in a nursing home for an extended time.
These steps can help you make sure you have the coverage you need…when you need it:
- If you have traditional Medicare, check Medicare Supplement (Medigap) and part D (prescription) plan to fill in the gaps
- Look at Medicare Advantage plans to see if they cover your needs (and for added benefits like gym memberships and other wellness benefits)
- Review private insurance plans for dental, hearing, and eye care as well as other needs.
- For extended non-medical needs like home care, look into long-term care coverage (be aware, these usually get more expensive as you get older)
You can do this on your own, but it takes a lot of research.
To save time and reduce frustration, talk to a certified Medicare advisor. They can help you review your medical and financial needs to find coverage that works for you…both within Medicare and outside.
My goal, as a certified Medicare advisor, isn’t just to understand what Medicare covers. It’s also to help you figure out what to do about the things Medicare doesn’t cover.
If you have any questions, feel free to call me at (832) 773-7981, email me at scott.goodell@ghstx.com, or use my contact form.
Scott Goodell
Goodell Health Solutions
Disclaimer:
The information provided by Goodell Health Solutions is for general informational purposes only and should not be considered legal, financial, or medical advice. We are licensed Medicare insurance agents, and our role is to help you understand your Medicare options.