7 Unexpected Things That Medicare Won’t Cover
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November 10, 2023
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Medicare provides about 64 million older Americans with affordable health insurance; for many, this is the only coverage they have. However, it’s important to remember that this federal program doesn't cover everything, making it essential to plan for the remaining expenses.
Here are some frequently needed healthcare services that are not covered by Medicare.
Pro Tip: One of the best ways to augment Medicare coverage is through Medigap. To learn more, read our guide to this year’s best Medigap providers.
1. Long-Term Care
Long-term care includes any service dedicated to assisting a person with their activities of daily living (ADLs), such as bathing, dressing, and eating. As such, long-term care is considered personal (not medical) care and is not covered by Original Medicare (Parts A and B).
Original Medicare does cover long-term services such as stays in skilled nursing facilities (up to 20 days without payment), at-home care, and hospice care.
Some Medicare Advantage and Medigap plans offered by private companies offer long-term coverage, but terms and costs vary widely, so you’ll want to check with your insurer before purchasing a plan.
2. Hearing Aids
Per the Medicare website, Original Medicare does not cover hearing aids or fitting exams for them. Hearing aids were excluded from the 1965 Medicare Act on the basis that they were routine and low in cost. As a result, you must pay for any costs related to receiving hearing aids.
Medicare Advantage plans sometimes offer coverage for hearing aids and other devices. Companies such as Aetna offer coverage for fitting exams, as well as discounts on hearing aids for patients.
Did You Know: If you’re looking for a pair of affordable hearing aids, be sure to check out our guide to the best cheap hearing aids.
3. Dental Care
Original Medicare does not cover dental care, such as dentist visits, but there are some exceptions. Parts A and B sometimes cover costs related to dental care received during hospital visits, such as reconstructive jaw surgery or tooth extraction before major surgery.
Depending on your location, annual dental care (cleaning and examination) can cost anywhere from $75 to $200 a year, sometimes higher with the addition of deep cleanings or X-rays.
Like other categories, some Medicare Advantage plans offer coverage for dental services. Additionally, there are many affordable dental insurance plans for seniors.
4. Vision Care
Original Medicare covers ophthalmologic care such as cataract surgery, but it does not cover routine eye exams, glasses, or other assistive devices. Under Original Medicare, you must pay for these services out of pocket.
Some Medicare Advantage plans offer optical care, as do vision-specific plans offered by private companies. Note that Advantage plans are often location-based, so be sure to research Medicare Advantage plans in your area. Additionally, there are several affordable dental and vision insurance plans for seniors.
5. Health Care Overseas
Unfortunately, Original Medicare does not cover any health costs you may have while traveling overseas. Luckily, Medigap plans can offer coverage in this area. Medigap plans can cover up to 80 percent of international needs, as long as you have paid your deductible and are within your plan’s maximum limit.
6. Prescription Medications
Original Medicare does not cover prescription drugs and medications apart from those administered in a hospital setting. To be covered for prescription drugs, you’ll need to purchase either a Medicare Part D policy or a Medicare Advantage plan with Part D coverage.
Elsewhere, you can save on prescriptions by using a free prescription discount card.
7. Deductibles and Copays
No matter what kind of coverage you want, there will always be out-of-pocket deductibles and copays. Many people manage these expenses with Medigap plans and supplemental insurance that are designed to fill in “gaps” in Original Medicare.
Bottom Line
While Original Medicare does cover many services, it is easy to forget that it does not cover everything. As you live your life, unexpected health issues and costs will appear, and you may not be covered! Be sure to plan ahead financially for these situations to make your future easier.