For millions of Americans, Medicare is a critical safety net, helping to shoulder the burden of healthcare costs as they move into their senior years.
But despite its comprehensive reputation, there’s a surprising array of medical services and treatments that original Medicare doesn’t cover.
These gaps in coverage can lead to unforeseen expenses, leaving beneficiaries vulnerable and in need of additional insurance solutions.
In this guide, we’ll take a deep dive into what’s not included in that iconic Medicare coverage, and what you can do to bridge the coverage gap.
Here’s a comprehensive look at the services and treatments that you may not know are excluded from your Medicare plan—but perhaps should.
1.) Long Term Care
A common misconception is that Medicare provides for long-term care, but it does not. Medicare coverage is limited to short-term skilled nursing facility care following a hospital stay. Long-term care options typically must be financed through other means, such as long-term care insurance, Medicaid (for those who qualify), or out-of-pocket payments.
2.) Foreign Travel
When venturing beyond the borders of the United States, you will find that Medicare coverage is limited. With a few exceptions for emergency situations close to the US border or on a cruise ship, health care received abroad is not covered by traditional Medicare plans.
3.) Routine Foot Care Coverage
Services such as foot exams or treatment for conditions like flat feet, corns or calluses, are generally not covered under original Medicare. Only foot care that’s considered medically necessary, such as diabetic-related issues, may be included.
4.) Routine Vision Coverage
Medicare generally does not cover routine eye exams or eyeglasses/contact lenses. However, it may cover a yearly eye exam if you’re at high risk for glaucoma or diabetic retinopathy.
For those who desire vision coverage, additional vision plans or Medicare Advantage Plans with vision benefits are available.
In addition, there are many combo plans that cover vision, dental, and hearing benefits that can be purchased in addition to any other health insurance coverage that you might have.
5.) Routine Dental Coverage
Don’t expect Medicare to pick up the tab for routine dental visits, cleanings, fillings, or dentures.
These are out of pocket costs unless you have a separate dental insurance policy or a Medicare Advantage Plan that offers dental benefits.
6.) Hearing Aids Coverage
The cost of hearing aids can be substantial, but Medicare does not cover hearing aids or the exams needed for fitting them.
Some Medicare Advantage Plans may provide supplemental hearing coverage.
Just like Medicare not covering routine dental coverage, you can also purchase a separate combo policy that will provide coverage for hearing benefits.
7.) Prescription Drug Coverage
Original Medicare, made up of Part A and Part B, does not include coverage for most prescription drugs
. To get this coverage, you can enroll in a separate Medicare Prescription Drug Plan, known as Part D, or choose a Medicare Advantage Plan that includes drug coverage.
Some key points to always consider when shopping for Prescription Drug Coverage (Part D) are:
- The lowest monthly premium doesn’t necessarily mean the lowest total out-of-pocket costs for the year. Some low-priced plans have higher co-pays than others.
- Keep an eye on what tiers your prescriptions fall into. One plan may have your drug listed as a Tier 1 (lowest co-pay), but another might have it listed as Tier 2 (higher co-pay).
- Make sure all your drugs are covered on the plan’s formulary.
Beyond What Medicare Does Not Cover
Knowing what Medicare doesn’t cover allows you to explore supplementary insurance options and make necessary financial plans. For additional coverage, consider Medicare Advantage Plans or separate policies that fill these gaps.
It’s essential to perform due diligence and determine the best choice for your health and budget. Always consult with a knowledgeable Medicare advisor or insurance professional before making decisions about your health care coverage.
Stay informed and plan for what Medicare doesn’t provide, ensuring you have comprehensive healthcare coverage that meets your needs throughout your golden years. Call Senior Benefit Services, Inc. today at (800)924-4727 to make sure you have the coverage you need.
