7 Smart Changes Medicare Doesn’t Cover: Personal Finance

Kate Ashford

By age 65, you may have a good idea of ​​what your health insurance covers and doesn’t cover. But Medicare is another beast — there are some surprising things that aren’t covered by Medicare.

Medicare is the federal government’s health insurance for people age 65 and older and others with disabilities and certain chronic conditions. Here are seven things Medicare doesn’t cover:

1. Deductibles and coinsurance

If you choose Original Medicare, both Medicare Parts A (hospital insurance) and B (medical insurance) have out-of-pocket costs in the form of deductibles and coinsurance. This can get expensive if you have medical needs, and there is no out-of-pocket cap on original Medicare spending.

People are also reading…

“Many people who enroll in traditional Medicare get a Medigap plan to help cover those costs and make their out-of-pocket costs more predictable,” said Gretchen Jacobson, vice president of Medicare at Federal Funds, which is A healthcare system dedicated to promoting high performance.

If you’re in a Medicare Advantage plan offered by a private insurance company that contracts with the federal government, you’re also responsible for any deductibles, copays, or coinsurance you need when seeking health care. While Medicare Advantage has a cap on out-of-pocket costs, that limit could be as high as $7,550 by 2022.

2. Daily dental care

While Medicare Part A covers some dental services you may get while you’re in the hospital, it doesn’t cover basic dental care such as cleanings, X-rays, and fillings. If you want coverage, you must purchase a separate dental policy.

You can get some coverage by purchasing a Medicare Advantage plan with dental benefits. “But those benefits may be limited, or the Medicare Advantage plan may require you to pay extra for those benefits,” said Lina Walker, vice president of health security at the AARP Public Policy Institute.

3. Eye exam

Medicare does not cover eye exams for eyeglasses or contact lenses or the eyeglasses or contact lenses themselves. Medicare Part B does cover a pair of eyeglasses or contact lenses if you have cataract surgery. (After the $233 Part B deductible in 2022, you’ll pay 20%.)

4. Hearing aids

Medicare also does not cover hearing aids or tests needed for hearing aids. While there is some language in the Build Back Better Act to add hearing aid coverage to Medicare, the bill has yet to pass Congress. Medicare covers diagnostic hearing tests if your doctor thinks you need it.

5. Prescription Drugs

Original Medicare Parts A and B do not provide prescription drug coverage. If you want prescription drug coverage, you must buy a Medicare Part D plan from a private insurance company or get prescription drug coverage from a Medicare Advantage plan that includes it.

Medicare drug coverage is optional, but if you choose to skip it and you don’t have other reliable drug coverage, you will pay a late enrollment penalty if you decide to enroll in the future. You’ll pay this penalty as long as you have Medicare drug coverage, so once you’re eligible, it pays to make sure you get and maintain eligible coverage.

6. Long-term care

According to the U.S. Department of Health and Human Services, someone who turns 65 today has a 7 in 10 chance of needing long-term care at some point in the future, which can be a significant expense. But if long-term care is the only care you need, Medicare doesn’t cover it.

“This is an area where there may be some confusion because people hear that Medicare covers nursing services,” Walker said. Medicare does cover skilled nursing facility care if recommended by your doctor after an eligible three-day hospital stay. In these cases, Medicare covers the first 100 days of care plus a daily coinsurance. After that, you will be responsible for all costs.

Medicare Advantage plans may offer some additional limited benefits. “Some Medicare Advantage plans offer home help, but coverage is very limited right now, and relatively few plans offer this service,” Jacobson said.

7. Overseas medical treatment

Medicare does not cover health care or supplies if you are outside the U.S. and certain U.S. territories, except in some very special circumstances. (For example, if you are traveling through Canada between Alaska and another state during a medical emergency, and the Canadian hospital is closer than the U.S. hospital, Medicare may cover your care.) Otherwise, you will need to find supplements where you live countries to purchase travel or purchase insurance.

This is a key point if you plan to move out of the country. If you change your mind and want to return to the United States and re-enroll in Medicare, you may be subject to Part B penalties. “It’s important that before they move, they figure out what will happen to them if they drop health insurance,” Walker said.


Leave a Reply

Your email address will not be published. Required fields are marked *