Although around 10,000 Americans turn 65 every year, qualifying them to receive Medicare benefits, few people understand the limits of the program. This lack of knowledge, particularly regarding what Medicare doesn’t cover, can come at a steep cost. After all, just because Original Medicare doesn’t cover a service, that doesn’t mean you won’t need it.
In this post, we look at the more common items not included in Original Medicare, as well as some options to help pay for them.
Dental, Vision, and Hearing: The No-Coverage Trinity
Quick, name three age-related health issues. If you said dentures, failing eyesight, and hearing loss, you were probably really good at “Family Feud.”
In fact, these issues are so common as we age, few people realize that Medicare does not cover even basic dental, vision, and hearing care.
Medicare does not cover routine dental care, including cleanings, fillings, and extractions. It also does not cover age-related services, such as dentures and dental implants. However, Medicare Part A may cover emergency or “complicated” dental procedures performed on an inpatient basis.
Generally, Medicare only covers vision tests if a patient has diabetes or glaucoma. If the intention is an eye exam such as you take for prescription lenses, Medicare does not cover it. Nor does the program cover glasses or contact lenses.
However, Medicare will cover cataract surgery and diagnostic testing beforehand, as well as prescription lenses required following your surgery.
Medicare does not cover hearing aids, routine hearing exams, or hearing aid fitting exams. However, if your doctor orders a hearing exam as a diagnostic tool, Medicare Part B covers it.
Medicare Doesn’t Cover Long-Term Care
Every year, more than 6 million Americans over age 65 require some type of long-term care. Typically, this takes the form of assistance with the activities of daily living and instrumental activities of daily living, including eating and cooking, bathing and dressing, and performing household chores. The need may arise due to the progression of a chronic illness. Or, it may be temporary and the result of an injury.
Although it is a common part of aging, Medicare does not cover most long-term care. Generally, these services are only covered it your doctor expects them to be of a finite duration. That means that he or she expects your condition to improve in a reasonable amount of time with treatment. In addition, the services covered must require the skills of a healthcare professional. In other words, the above-mentioned long-term care services – cooking, eating, dressing, etc. – are not covered by Medicare.
For more information on which services Medicare covers, please see our post, Does Medicare Cover Long-Term Care?.
Medicare Doesn’t Cover Care Received Outside the U.S.
If you plan to fill your passport once you retire, you should know that Medicare only covers foreign healthcare in rare circumstances.
- You have a medical emergency while in the United States but the closest hospital is in another country.
- You live in the United States but the closest hospital to your home is in another country.
- You have a medical emergency while driving through Canada, during a trip between Alaska and the lower 48 states, and the closest hospital is in Canada.
- Medicare may cover healthcare services received on a cruise ship within 6 hours of an American port.
Obviously, none of these scenarios match the common idea of “foreign travel.”
Hospital Observation and Medicare
Often, people wind up in the hospital under observation, meaning they are never formally admitted. You can spend 24 hours or more actually in a hospital room without ever being admitted.
Hospital staff may place you under observation to determine whether your condition warrants admission. If the doctor decides no and sends you home, Part A does not cover any care received as an outpatient. You may have coverage under Part B, depending on the services received.
You may also be placed under observation and admitted much later. Any care received while under observation is not covered by Part A.
If you are not admitted and then require follow-up care, such as physical therapy, Medicare does not cover these services.
Other Services Not Covered by Medicare
Finally, there are “miscellaneous” services not covered by Medicare. This includes:
- Routine foot care, although Part B covers treatment for injuries and diseases such as bunions and heel spurs.
- Cosmetic surgery, unless it’s required after an accidental injury, breast reconstruction following a breast cancer mastectomy, and to improve function of a malformed part of your body.
- Acupuncture, although many private insurance companies now cover this treatment.
How Can You Get Coverage for These Services?
Although Original Medicare does not cover the above services, you do have options.
- Many Medicare Advantage (MA) plans offer services beyond those covered by Original Medicare. Plans vary widely, though, so research and review your options carefully. In addition, coverage tends to be limited. Make sure you understand the full details before choosing a plan.
- Some Medigap plans cover healthcare services received in another country.
- Ancillary insurance is a common choice, particularly for vision and dental care.
- To cover long-term care, you may purchase long-term care insurance or a life insurance policy that allows you to draw from it to cover these costs.
To learn more about your Medicare plan options, call us toll-free at 855-350-8101. One of our licensed agents will work with you to determine the best plan – or plans – to fit your unique needs.
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