Medicare is a health insurance program developed for seniors over the age of 65 and for people under the age of 65 for certain disabilities. Although this program does help alleviate many medical expenses, not everything is covered. There are different medicare plans available and it is important to have a general understanding of them to know when you will need to pay for out of pocket expenses, such as for hearing, vision and dental. There are two parts to the program–Part A, hospital insurance and Part B, medical insurance. Here is a list of some of the things medicare does not cover:
1. Prescription drugs
The basic Medicare plan does not offer any coverage for prescription drugs, however there are other options available from private insurance companies if you need coverage. Medicare Part D Prescription Drug Plans (PDPs) as well as Medicare Advantage (Part C) both provide varying options for drugs.
2. Long-term nursing home care
Although Medicare does not generally cover long-term care, you can still use it for other services in the nursing home, such as medical supplies and visits from a physician. You may also be eligible for Medicaid alongside Medicare, as most nursing homes accept Medicaid for admission.
3. Routine eye care, hearing exams and hearing aids
While the original Medicare does not provide coverage for hearing exams or hearing aids, there are some Medicare Advantage plans that can help. There is no coverage for vision care, including eye exams, eyeglasses or contact lenses.
4. Preventive dental checkups
The original Medicare does not provide coverage for routine dental exams, dental work or dentures. There may still be annual limits you can use through Medicare Advantage, such as the common dental limit of $1,500 per year.
5. Medical care for international travel
If you or your family travel often, it’s a good idea to look into Medigap (a supplement plan), as there are some plans that can cover the costs that Medicare does not, up to 80%. Medicare Advantage plans also provide coverage for emergency medical costs out of the country.
6. Cosmetic surgery
Medicare will not cover cosmetic surgery, with some exceptions. For example, the program may approve coverage to repair skin burns, facial injuries after an accident, or other types of cosmetic surgery required for therapeutic reasons.
7. Deductibles and coinsurance
Although there is coverage for hospital stays under Plan A, and doctors visits and outpatient care under Plan B, you are still responsible for the deductibles and copayments before any coverage actually begins. This can get pricey, especially if you have a lot of medical needs. For example, Plan B covers 80% of doctors’ services but you will have to pay the remaining 20% after a $233 deductible. A Medicare supplement policy will help cover the gaps here.
