What Does Medicare NOT Cover? 7 Services Not Included in Your Coverage
While Medicare is designed to help retirees and persons with disabilities cope with the rising cost of healthcare, it cannot cover everything. Some might have the misconception that having Medicare will result in zero billing, but that’s far from the reality. It’s true that the program covers plenty, but this is still not enough. If you are counting on Medicare to shoulder all your possible medical emergencies, then you’ll eventually find yourself with a huge problem when such a time comes.
With that said, you need to know what Medicare does NOT cover so that you can prepare a contingency plan.
Medicare Part A and Part B
Traditional Medicare (AKA Medicare A and B or Original Medicare) pays for a huge part of your medical expenses after retirement (65 years old). Part A is equivalent to hospital insurance and will help shoulder skilled nursing care facility stays, inpatient hospital stays, hospice care, surgery and some types of home health care. Meanwhile, Part B, which is equivalent to medical insurance, will help pay for outpatient care, doctor’s appointments, some preventive care services and supplies. You can obtain the services of any hospital or doctor that takes Medicare anywhere in the United States.
So you probably already the details on what Medicare covers; are you aware of what it does not? Here we talk about the seven common medical products and services not included in your plan.
1. Dental Care
Original Medicare will not provide coverage for teeth cleanings, dentures, fillings, routine dentist visits and most types of tooth extractions. When you sign up for Medicare Advantage, you might get basic coverage for x-rays and simple cleanings, but these usually have an annual limit. To make sure that you are prepared for your dental health needs, you can purchase a separate dental discount policy or dental insurance plan.
Note that Medicare only shoulders treatments that are “medically necessary,” as with a root canal that might need to be done prior to a heart surgery. Plus, dental services typically cost hundreds and thousands of dollars, too, so having a dental insurance policy might be a good option. Otherwise, you can search your location for dental schools that might be willing to provide discounted rates for certain services.
2. Vision Care
If you need glasses, contact lenses or even just an eye exam, know that Medicare will not help you pay for routine services. As with dental, vision care products and services can be costly, so preparation is key. On the upside, you can purchase contacts or eyeglasses cheaper online, but the payment won’t be from Medicare.
3. Hearing Aids
Hearing aids typically cost thousands of dollars—and some advanced auditory gadgets can cost as much as $10,000. Unfortunately, Medicare does not cover any of these, nor the exam required to be fitted for any accessory. If this is a huge concern, then you might want to consider Medicare Advantage instead as some plans offer coverage for exams and certain types of hearing aids.
4. Long-term Care
Long-term care, usually in a nursing home setting, can cost thousands of dollars every month, so if you’re not ready for this expense, it could eat into your retirement savings (granted that you have one). Although Medicare does cover some services under skilled nursing care, it will not shoulder the costs related to simply getting old or sick and then needing assistance with ADL (activity of daily living) routines. These custodial care needs might include dressing, bathing and other usual self-care activities that you can no longer perform on your own.
That said, it would be wise to begin preparing for this possible expense while you’re young. However, if you’ve already left the workforce or are already nearing the retirement age, then you might want to consider getting another insurance policy that covers long-term care.
5. Alternative Care
Medicare does not provide assistance for alternative treatments, like acupuncture or chiropractic procedures. If you need such services to manage your aches and pains or to maintain good health in general, expect to shell out for these yourself. Some Medicare Advantage and Medicare Supplement (Medigap) policies offer limited coverage for certain kinds of alternative therapies, so be sure to discuss these with your chosen provider. Some alternative health clinics also offer discounts based on age, so be on the lookout for these, as well.
6. Cosmetic Surgery
To reiterate, Medicare covers only those that a medically necessary, so enhancements are definitely out of the picture. What it can cover, however, are those that are needed either to improve the function of the area that requires surgery or to address an accidental injury (depending on the evaluation). It also provides assistance for breast prosthetics/breast reconstruction following from a breast cancer-related mastectomy.
7. Prescription Drugs
Outpatient prescription medications are not covered, though you can purchase a separate prescription-drug plan (Medicare Part D) or a Medicare Advantage policy (Part C) separately. You can enroll in either when you have Part A and Part B or when your other drug coverage lapses (usually private).
Another important thing to note about Medicare coverage is that it will only shoulder your expenses from services and procedures performed inside the United States. If you receive care while traveling outside the country, that will unfortunately be an out-of-pocket expense—UNLESS, you have a Medicare Supplement plan (C, G, M, N) which can coverage as much as 80 percent of the cost of emergency medical needs abroad (lifetime cap of $50,000).
Medicare Supplements are paid in addition to your Original Medicare policy, and it is strongly advised that you enroll in one when you are first eligible to ensure approval and get the lowest price available.
To learn more about what Medicare can and cannot do for you, or if you’re curious about what benefits Medicare Supplement plans bring, get in touch with us at 800-354-1078. Our team of Medicare specialists are always ready to answer your questions and provide the guidance you need in making the right policy decisions for retirement.
