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Section 1: Medicare Essentials 
 

8 Surprising Things Medicare Doesn’t Cover

How to afford the expenses you might encounter

 

ESTIMATED READ TIME: 5 MINUTES

 

  

IN THIS ARTICLE

 

•  Dental care
•  Some vision care
•  Hearing care
•  Health care abroad
•  Cosmetic surgery
•  Long-term nursing care
•  Prescriptions
•  Out-of-pocket costs

 

Government-sponsored health care doesn’t mean free. As you learn more about Medicare’s rules, you’ll find that entire areas of care that you might have gotten used to as part of your insurance package at work is now not covered at all. Plus, you’ll have to pay premiums, deductibles, copayments and coinsurance like you’ve had in your job’s insurance plans.
 

1. TEETH CLEANINGS AND ROOT CANALS

 

Original Medicare, which consists of Part A hospitalization and Part B doctors’ services and outpatient care, doesn’t cover routine dental care. So you’re on your own paying for checkups, cleanings, fillings and even big-ticket items such as crowns, dentures and root canals though you may have some coverage for procedures that you have in a hospital or require you to be hospitalized.

 

The fix, option 1: If you choose a private Medicare Advantage plan rather than original or traditional Medicare, you may have some help with dental costs. Many Medicare Advantage plans cover preventive care, such as dental exams, annual X-rays and routine cleanings. Some plans cover dental procedures up to an annual limit, typically capping coverage at $1,000 to $1,500 a year.

 

The fix, option 2: Buy a separate private dental insurance policy that covers a portion of your expenses. These policies may cover preventive care; 50 percent of the cost of major services, such as root canals; and 80 percent of the cost of smaller procedures, like extractions, up to an annual limit. You may be required to use dentists in the insurer’s network.

 

Another option: Dental discount programs also can help reduce your costs but are not insurance.

 

2. EYE EXAMS AND GLASSES

 

Get ready to pay for vision care, too. Original Medicare covers some major procedures, such as cataract surgery, but it doesn’t cover routine eye exams, glasses or contact lenses.

 

The fix, option 1: Some Medicare Advantage plans cover routine vision care. A plan may cover an annual exam with an in-network provider and pay up to a certain amount for glasses or contact lenses each year.

 

The fix, option 2: Buy a separate private vision insurance policy.

 

Another option: Find eyewear discounts online that can give you some savings.

 

3. HEARING AIDS AND EXAMS

 

You may need more help with your hearing as you get older, but original Medicare generally doesn’t cover these costs. Medicare doesn’t pay for routine hearing tests or hearing aids, which can cost more than $1,000 each. Medicare will cover a hearing exam if your doctor or health care provider orders the test to see if you need medical treatment.

 

The fix: Some Medicare Advantage plans provide hearing coverage. A plan may cover one routine hearing exam with an in-network provider each year. It also may cover hearing aids with a copayment, which can be several hundred dollars, or provide discounts for them.

 

Another option: Buy a discount plan for hearing aids or shop around for lower-cost hearing aids at retail stores or online.  

 

illustration of a woman with a suitcase standing in front of a world map


4. MEDICAL EXPENSES WHEN TRAVELING OUTSIDE THE U.S.

 

If you get sick while traveling abroad, you may get stuck with big bills. Medicare usually doesn’t cover health care costs when you take trips outside the United States. These expenses can be particularly high if you need emergency air transportation to a hospital.

 

The fix: Several types of Medicare supplement plans, known as Medigap policies, offer some foreign travel coverage. They typically cover 80 percent of the charges for emergency care outside the U.S. with a lifetime limit of $50,000. Some Medicare Advantage plans provide limited coverage for emergency care outside the U.S. Check with your plan before traveling.

 

Another option: Buy a travel insurance policy for your trip. It may cover emergency health care and medical evacuation while you’re abroad. Not all travel insurance policies provide health care coverage, and many exclude preexisting conditions. Check the details before selecting a policy.  

 

5. COSMETIC SURGERY

 

Want a tummy tuck or face-lift? Like most other health insurance plans, Medicare doesn’t cover elective cosmetic surgery, so you might want to embrace the body you have now while exercising to keep fit.

 

The fix: You’ll have to dip into your savings if you want to look like a movie star. Yes, some plastic surgeons offer finance plans through medical lenders, but interest rates will be closer to a credit card’s than what you’re getting at the bank.

 

Another option: Medicare may cover a procedure that’s generally considered cosmetic if you need it because of an injury or to improve the function of a malformed body part. For example, Medicare may cover rhinoplasty (a nose job) if you get prior authorization from a doctor who says the surgery is necessary because you’re having trouble breathing. Medicare also covers breast prostheses if you had breast cancer and a mastectomy. And it covers bariatric surgery when you have certain medical conditions related to morbid obesity.

 

6. NURSING HOME CARE

 

Long-term care is one of the largest expenses you may face as you get older, and it’s one of Medicare’s biggest gaps. Medicare pays for limited stays in skilled nursing facilities — for example, if you have a hip replacement and need inpatient physical therapy for several weeks. But it generally doesn’t pay for nursing home costs if you primarily need help with the activities of daily living, such as bathing, dressing and eating.

Long-term care costs can add up quickly: The median cost of a private room in a nursing home is now more than $108,000, according to the 2021 Genworth Cost of Care Study. The median cost of a year in an assisted living facility or 40 hours a week of home care is about $55,000.

The fix: A long-term care insurance policy can help cover these expenses for some people. This type of policy can help pay for care in an assisted living facility, nursing home or your own home.

 

To qualify for benefits, you usually need help with two out of six activities of daily living, such as bathing, dressing or eating, or evidence of cognitive impairment. However, it can be difficult to qualify for long-term care insurance if you already have health issues, and the premiums for these policies have been rising over the past several years.

 

Another option: Buy a policy that combines long-term care and life insurance, though the price can be steep. This type of policy pays your heirs a death benefit if you don’t need long-term care.

 

Also an option: Medicaid, a joint federal-state program that provides health coverage for people with low incomes, may pay for these costs if you meet the asset and income requirements and have very little savings. If you qualify, you may be required to use certain Medicaid-eligible facilities.

 

No matter how you decide to cover these potential expenses, it’s important to consider the costs in your retirement planning.

 

illustration of three shelves with pill bottles on them


7. PRESCRIPTION MEDICATIONS

 

You can’t count on parts A and B of Medicare to cover your prescription medicines. While original Medicare pays for some medications you receive in a hospital or doctor’s office, it generally doesn’t cover prescription drugs you take yourself.

 

The fix: If you have original Medicare, you can get stand-alone Part D prescription drug coverage from a private insurer to help cover your drug costs. Alternatively, you can purchase a Medicare Advantage plan that provides both medical and drug coverage.

 

Another option: People with limited income can get help with Part D premiums, deductibles and copayments through Medicare’s Extra Help program. Some states and drug companies offer pharmaceutical assistance programs for people with Part D coverage, too.

 

8. DEDUCTIBLES AND COPAYMENTS

 

Even when Medicare covers your medical expenses, you’ll still have out-of-pocket costs. In 2022, if you’re hospitalized, you have to pay a $1,556 Part A hospital deductible for each benefit period, which begins when you’re admitted as an inpatient to a hospital and lasts until you haven’t received inpatient care in either a hospital or skilled nursing facility for 60 days. 

 

Medicare pays for the first 60 days in the hospital for each benefit period, but you have to pay a portion of the cost after that — a $389 daily coinsurance charge for days 61 to 90. After 90 days, you’re billed a $778 daily coinsurance charge for up to 60 days, which can be used only once in your lifetime. Once you’ve used up those 60 days, you have to pay the full cost of hospitalization.

 

After you’ve left the hospital and have days remaining in your benefit period, original Medicare will pay for your first 20 days in a skilled nursing facility, too. You’ll have to pay $194.50 a day for days 21 to 100 and the full cost after that. Medicare Advantage plans have to provide at least that much hospitalization and skilled nursing facility coverage.

 

In 2022, the Part B deductible is $233, and you usually have to pay 20 percent of the costs of doctor visits and outpatient care. 

 

The fix: If you have original Medicare, a Medigap policy from a private insurer can cover many of these expenses.

 

Another option: You can buy your medical and drug coverage from a private insurer through a Medicare Advantage plan. These federally regulated plans must cover at least as many services as traditional Medicare but have different copayments and deductibles. They also have limits on out-of-pocket costs, a calculation that doesn’t include premiums. In 2022, federal regulations required Medicare Advantage plans to cap out-of-pocket costs at $7,550 for in-network providers and $11,300 when in-network and out-of-network costs are totaled.

 

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