What are the major things that Medicare does not cover?
While Medicare, especially Medicare Advantage, comes with many great and low-cost benefits, it does not cover all health care services that you may need after you turn 65.
Keep in mind that the following list includes things that Original Medicare
and the majority of Medicare Advantage plans do not cover. To make sure you
understand Medicare's limits and perhaps prompt you to check your Medicare
Advantage policy (if you have one), you should look at this list.
If the list includes a service you think you need, we offer a solution.
Care you receive benefits outside the United States
Original Medicare will not pay for any health care services you receive
while traveling abroad. Also, supplemental Medicare prescription drug plans
purchased by Original Medicare recipients do not cover prescriptions outside of
the United States.
What you can do: If you are planning to travel abroad,
you may want to look into a Medigap or Medicare Advantage plan from a private
insurer, as some may offer coverage if you are going overseas. If you can't
find one, you should consider travel insurance covering health care services.
Long-term care
Original Medicare and Medicare Advantage are great for regular doctor's
visits and any procedures you may need, like surgeries or other therapies.
However, they do not cover long-term care costs that can mount quickly.
Long-term care is defined as medical and non-medical services for people who
cannot perform basic daily tasks like dressing or bathing independently. People
who need long-term care can hire someone to come into their home or be cared
for at an assisted living facility or nursing home. This type of care is
typically not dispensed in hospitals, which can be extremely costly.
Consider the following long-term care scenarios and their average costs:
- In-home health aide: $4,576
per month
- Assisted living facility:
$4,300 per month
- Nursing home semi-private
room: $7,756 per month
- Nursing home private room:
$8,821 per month
What you can do: One option is to secure long-term
care insurance, but that should be done as early as possible as the premiums
grow exponentially as we age, and if you have certain health conditions, it may
be out of reach.
Some life insurance policies also offer “living benefits” or “accelerated benefits”. Other policies may have long term care riders.
Dental care
Original Medicare does not cover dental care like cleanings, fillings and
tooth extractions. Enrollees will have to pay those costs out of pocket.
What you can do: Some, but not all, Medicare Advantage
plans cover preventative dental care like cleanings and routine exams, and some
cover comprehensive care as well, such as crowns and extractions. With most
plans, preventive care does not have a maximum yearly amount. There are
also many stand-alone dental plans available.
Hearing aids
As people age, many experience hearing loss, but while Original Medicare
would pay for treatment, it does not cover hearing aids and you will have to
pay 100% of the cost yourself. That said, it usually covers 80% of
diagnostic hearing exams to determine if you need treatment.
What you can do: Most major insurers that offer
Medicare Advantage plans have at least one plan that covers hearing aids.
Routine vision care
Original Medicare typically neither covers exams for eyeglasses or contacts
nor the cost of glasses or contact lenses. Enrollees will have to pay for
those themselves.
However, it does cover screening for glaucoma, cataracts or macular
degeneration, and eye exams for patients with diabetes, as well as treatment.
What you can do: Certain Medicare Advantage plans
cover eyeglasses, intraocular (artificial) lenses, and contact lenses. If you
need corrective lenses, you may want to look for a plan that offers this
coverage during your next open enrollment. Again, there are also stand-alone
vision plans.
Your licensed health insurance broker can offer these policies.
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