By the time you turn 65, you’ll likely have a pretty good sense of what health insurance does and doesn’t cover. But Medicare is a different beast — and there are some amazing things that just don’t fall under the Medicare umbrella.
Medicare This is the federal government’s health insurance coverage for people age 65 or older, and other people with disabilities and certain chronic conditions. Here are seven things Medicare does not cover:
1. Discounted amounts and coinsurance
If you choose Original Medicare, both Medicare Part A (hospital insurance) and Part B (medical insurance) require out-of-pocket spending in the form of deductibles and co-insurance. If you have medical needs, this can get expensive, and there is no cap on Original Medicare spending.
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“A lot of people on traditional Medicare get Medigap . plan To help cover these costs and make their personal costs more predictable,” says Gretchen Jacobson, vice president of Medicare for the Commonwealth Fund, a private institution with a mission to promote a high-performing health care system.
If you sign up for Medicare benefits plan, offered by private insurers that contract with the federal government, you will also be responsible for any deductibles, co-payments or co-insurance required when seeking health care. Although there is an outside cap on Medicare Advantage, that limit can be as high as $7,550 in 2022.
2. Routine dental care
Although Medicare Part A covers some dental services you may get as part of a hospital stay, basic dental care such as cleanings, X-rays, and fillings are not covered. If you want coverage, you will have to purchase a separate dental policy.
You may be able to get some coverage by purchasing a Medicare Advantage plan with dental benefits. “But these benefits can be limited, or Medicare Advantage plans can require you to pay extra for these benefits,” says Lena Walker, vice president of health security at the AARP Institute for Public Policy.
3. Eye examinations
Medicare does not cover eye exams for eyeglasses or contact lenses, eyeglasses or the contact lenses themselves. Medicare Part B covers one pair of eyeglasses or contact lenses if you have cataract surgery. (After deducting Part B of $233 in 2022, you’ll pay 20% of costs.)
4. Hearing aids
Medicare also does not cover hearing aids or required tests for hearing devices. While there are some statements in the Build Back Better Act to add hearing aid coverage to Medicare, the law has not yet been passed through Congress. Medicare covers diagnostic hearing tests if your doctor thinks you need them.
5. Prescribed medicines
Medicare Original Parts A and B do not provide coverage for prescription drugs. If you want to cover prescription drugs, you must buy Medicare Part D Plan from a private insurance company or get drug coverage from the Medicare Advantage plan that includes it.
Medicare drug coverage is optional, but if you choose to skip it and don’t have other trustworthy drug coverage, you’ll pay the late enrollment penalty if you decide to enroll at a later time. You’ll pay this penalty for as long as you have Medicare drug coverage, so it’s a good idea to make sure you get and retain eligible coverage once you qualify.
6. Long-term care
A 65-year-old person today has a roughly 7 in 10 chance of needing long-term care at some point in the future, according to the Department of Health and Human Services, and that can be a significant cost. But Medicare does not cover long-term care if it is the only care you need.
“There may be some confusion in this area, because people have heard Medicare covers nursing services,” Walker says. Medicare covers skilled nursing facility care if your doctor recommends it after a qualifying three-day hospital stay in an inpatient setting. In these circumstances, Medicare covers the first 100 days of care in addition to the daily co-insurance fee. After that, you are responsible for all costs.
Medicare Advantage plans may offer some limited additional benefits. “Some Medicare Advantage plans offer help at home, but it’s very limited coverage at this point, and relatively few plans provide that,” Jacobson says.
7. Health care abroad
If you are outside the United States and certain areas of the United States, Medicare does not cover health care or supplies except in some very specific circumstances. (For example, if you are transiting through Canada between Alaska and another state when you have a medical emergency, and a Canadian hospital is closer than a US hospital, Medicare may cover your care.) Travel coverage or purchase insurance in the country where you live.
This is an essential point if you are planning to get 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, before they move, that they find out the implications for them if they forego medical care,” Walker says.