En español | Medicare covers the majority of older Americans’ health care needs — from hospital care and doctor visits to lab tests and prescription drugs. Here are some needs that aren’t a part of the program — and how you might pay for them.
1. Opticians and eye exams
While original Medicare does cover opthalmologic expenses such as cataract surgery, it doesn’t cover routine eye exams, glasses or contact lenses. Nor do any Medigap plans, the supplemental insurance that is available from private insurers to augment Medicare coverage. Some Medicare Advantage plans cover routine vision care and glasses.
Solution: For some people, it makes sense to buy a vision insurance policy for a few hundred dollars a year to defray the costs of glasses or contact lenses.
2. Hearing aids
Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids.
Solution: If you are in a Medicare Advantage plan, check your policy to see if it covers hearing-related needs. If it doesn’t, or if you have original Medicare, consider buying insurance or a membership in a discount plan that helps cover the cost of such hearing devices. Also, some programs help people with lower incomes to get needed hearing support. Or you can pay as you go. Congress passed legislation in 2017 that allows some hearing aids to be sold over the counter without a prescription. The Food and Drug Administration has until August to issue proposed guidelines for the sale of these devices.
3. Dental work
Original Medicare and Medigap policies do not cover dental care such as routine checkups or big-ticket items, including dentures and root canals.
Solution: Some Medicare Advantage plans offer dental coverage. If yours does not, or if you opt for original Medicare, consider buying an individual dental insurance plan or a dental discount plan.
4. Overseas care
Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs incurred outside the U.S.
Solution: Some Medigap policies cover certain overseas medical costs. If you travel frequently, you might want such an option. In addition, some travel insurance policies provide basic health care coverage — so check the fine print. Finally, consider medical evacuation (aka medevac) insurance for your adventures abroad. It’s a low-cost policy that will transport you to a nearby medical facility or back home to the U.S. in case of emergency.
NEW IN 2020
Limited acupuncture coverage
In 2020, Medicare added coverage for acupuncture for enrollees with chronic low back pain. Beneficiaries who have had lower back pain for 12 weeks or longer will be able to get up to 20 acupuncture treatments each year.
Allowing doctors, physician assistants, nurse practitioners and other qualified personnel to provide acupuncture to these beneficiaries is one alternative, federal officials say, to the increasing use of prescription opioids to handle chronic pain.
Routine medical care for feet, such as callus removal, is not covered. Medicare Part B does cover foot exams or treatment if it is related to nerve damage because of diabetes, or care for foot injuries or ailments, such as hammertoe, bunion deformities and heel spurs.
Solution: If you face these costs, you may want to set up a separate savings program for them.
6. Cosmetic surgery
Medicare doesn’t generally cover elective cosmetic surgery, such as face-lifts or tummy tucks. It will cover plastic surgery in the event of an accidental injury.
Solution: If you face these costs, you also may want to set up a separate savings program for them.
7. Nursing home care
Medicare pays for limited stays in rehab facilities — for example, if you have a hip replacement and need inpatient physical therapy for several weeks. But if you become so frail or sick that you must move to an assisted living facility or nursing home, Medicare won’t cover your custodial costs. (Nursing homes average about $90,000 a year for a semiprivate room and more than $100,000 for a private room. Costs vary based on where you live and what facility you choose.)
Solution: Planning for nursing home care is a big issue, with lots of choices and decisions. But for those with limited income and savings, Medicaid might help fill in the gaps.