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Senior Housing May 20, 2023
9 Surprising Things Medicare Doesn't Cover
by Jenn

9 Surprising Things Medicare Doesn’t Cover

Are you turning 65 this year? Then it’s time to think about Medicare. As you know, Medicare is a federal health insurance program for people 65 and older. It also insures younger people with certain disabilities.

Medicare covers most basic health care needs. Things like hospital care, doctor visits, lab tests, and some prescription drugs. But you may be surprised to discover at least 9 things Medicare won’t cover. Common things many older people need. And Medigap, a supplemental policy to Medicare, doesn’t usually cover them either.

1. Optical care and eye exams

Medicare will cover ophthalmologic expenses such as cataract surgery. But routine eye exams, glasses, or contact lenses are not included.

2. Hearing aids

Medicare does not pay for routine hearing tests or hearing aids. While hearing aids are expensive, prices have come down in recent years. Also, over-the-counter hearing aids are now available that might work for you.

3. Dental work

Original Medicare and Medigap policies do not cover any dental care. Routine checkups, cleaning, x-rays, dentures, fillings, and root canals are all out-of-pocket. There are some non-profit dental clinics serving seniors only. They offer services at a discount, but it’s still an out-of-pocket expense.

4. Podiatry

Routine foot care such as callus removal and in-grown toenails is not covered. But Medicare Part B might cover treatments related to a medical diagnosis. These would include diabetic foot care, foot injuries or ailments such as hammertoe, bunion deformities, and heel spurs.

5. Overseas care

If you frequently travel out of the country, be aware that your insurance does not follow you.

This means that if you’re overseas and have a heart attack, accident, or need hospital care, you’re on your own.

Also, if you should die while out of the country, Medicare will not cover the cost of bringing your body back to the U.S.

6. Cosmetic surgery

Medicare covers plastic surgery in the event of an accidental injury. Or if needed after another treatment or surgery. These would include breast reconstruction following a mastectomy or skin grafts following surgery. But it will not cover elective cosmetic surgery, like face-lifts or tummy tucks.

7. Chiropractic care

Most chiropractic services and tests are not covered by basic Medicare. But Medicare Part B now covers one manual manipulation of the spine to correct a dislocation. It might also cover some tests including chiropractic x-ray.

8. Massage therapy

?Medicare doesnt cover massage therapy. The exception is if its part of physical and occupational therapy prescribed by a doctor.

9. Nursing home care

Heres where most people get caught off guard. They think that nursing home care is part of Medicare and it is not.

Medicare pays for limited stays in rehab facilities. For example, if you have a stroke or a hip replacement and need inpatient therapy for several weeks. Beware though. People think they have 100 days of rehab after an event. That's rarely the case because of the strict criteria for coverage.

Additionally, many people discover rehab isn’t enough to achieve full recovery. They end up needing assisted living, long-term nursing home care, or an adult care home. These care settings are custodial care which is not covered by Medicare.

So, what are your options for covering the excluded expenses listed above?

When making Medicare decisions, start by assessing your current health level. Consider your diagnosis, chronic conditions, and your income and assets. Then plan for expected or unanticipated out-of-pocket expenditures. Also, realize that basic Medicare coverage has co-pays. Amounts vary based on the Medicare plan you choose. Plan how you'll pay for those too.

  1. Compare supplemental insurance Medigap plans. These plans are available from private insurers to augment Medicare coverage.
  1. You might also compare Medicare Advantage plans. Private companies contract with Medicare and offer managed plans charging premiums. They assume the responsibility of providing Medicare-equivalent insurance. Compare companies, plans, costs, and coverage. Some plans cover vision, dental, chiropractic, and acupuncture care. The more things they cover, the higher the premium.
  1. You might also consider purchasing "supplemental insurance". These would include vision and dental care plans. Again, compare the costs. Sometimes these policies don't cover major expenses.
  1. Set up a Medical Savings Account. Some HSAs are tax-deductible. And withdrawals are tax-free when used only for medical expenses.
  1. When traveling out of the country, consider traveler's insurance. Some short-term policies will cover emergency care. And there are policies specifically for deceased transport.
  1. The biggest issue is planning for nursing home care. Long-term nursing home care can deplete your assets, savings, and income. The average cost is about $90,000 a year for a semi-private room and more than $100,000 for a private room. Consult with an elder law attorney for estate planning.
  1. For those with limited income and savings, Medicaid might help fill in the gaps. Or better yet, check if there’s a PACE program in your area. PACE stands for Program of All-Inclusive Care for the Elderly. Find out more. Watch this short video:  How PACE Helps Lisa 

In summary, planning is key. As we age, we're likely to need more medical help. I recommend you meet with an independent insurance agent specializing in Medicare options. They'll help you consider the factors for risk assessment such as health and finances. They’ll help you consider each area, compare plans, and choose an insurance route that’s best for you.

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