What Does Medicare Not Cover?

While Medicare can provide essential health insurance coverage, it doesn’t pay for everything.

If you’re nearing the age of 65, qualifying for Medicare can provide you with essential health insurance coverage. According to the Kaiser Family Foundation, nearly 60 million Americans benefit from Medicare. However, you may be surprised to find out that Medicare doesn’t cover all of your healthcare expenses.

Original Medicare pays for only hospital coverage and medical insurance. Extra items and services, including prescription drug coverage, eye exams, and long-term care, aren’t covered. What Does Medicare Pay For?

Original Medicare is a federal insurance program available to people 65 and older. Original Medicare has two parts: Part A (hospital insurance) and Part B (medical insurance).

Part A Medicare Part A provides you with hospital insurance. In general, Part A coverage pays for the following: Inpatient care in a hospital

• Skilled nursing facility care

• Nursing home care (not covered when custodial or long-term care is the only care you need)

• Hospice care

• Home healthcare

You usually can get Part A coverage without paying a premium if you or your spouse worked and paid Medicare taxes while employed.

Part B Medicare Part B is the medical insurance portion of Original Medicare. Part B covers medically necessary services and supplies used to diagnose or treat your medical condition that meet accepted standards of practice. Part B also covers preventive care that prevents illness or detects it at an early stage, such as vaccines and mammograms. Examples of items and services covered by Part B include:

• Clinical research

• Ambulance services

• Durable medical equipment

• Mental healthcare

You have to pay a premium for Part B coverage. Most people pay the standard premium amount. For 2021, the standard premium is $148.50.

One of the most common questions is, What doesn’t Medicare cover? While Medicare does pay for a substantial portion of your healthcare costs, it doesn’t cover everything. According to the Centers for Medicare & Medicaid Services, several items and services are excluded from your Medicare coverage:

Dental Care If you need to visit a dentist for a cleaning, cavity filling, dentures, or root canal, be aware Medicare won’t cover your bill. Medicare does not pay for items or services related to the care or treatment of teeth or structures supporting the teeth.

Eye Exams for Prescription Glasses Medicare doesn’t pay for eye exams for prescribing or fitting eyeglasses or contact lenses. It also won’t pay for the lenses or frames.

Foot Care Typically, Medicare doesn’t cover routine foot care. If you’re seeking treatment for flat feet, care for calluses or corns, trimming or debriding nails, or orthopedic shoes, you’ll have to cover the cost yourself.

Hearing Aids Medicare does not cover the cost of hearing aid examinations or hearing aids. Long-Term Care Original Medicare does not cover custodial care or long-term care in the beneficiary’s home or institution. Custodial or long-term care is defined as personal care that does not require trained medical or paramedical personnel.

Prescription Drug Coverage Original Medicare does not include prescription drug coverage. If you’re prescribed brand-name or generic medication by a doctor, you’ll have to pay the cash price for the drugs; your Medicare coverage won’t pay for them.

However, you can get prescription drug coverage as an option benefit by purchasing a Medicare Part D plan.

How to Get Coverage for Extra Services If you need coverage for items or services that Original Medicare doesn’t cover, you have a workaround: You can enroll in a Medicare Advantage plan.

Medicare Advantage plans, also known as Medicare Part C, are plans offered by private insurance companies and approved by Medicare. Medicare Advantage plans combine your Part A and Part B benefits into one plan, and most plans also include prescription drug coverage, too.

They may cover additional services and items that aren’t covered by Original Medicare. For example, Medicare Advantage plans often cover vision, hearing, and dental care, and some will even pay for wellness programs.

In addition to your Medicare Part B premium, some Medicare Advantage plans have a monthly premium. According to the Kaiser Family Foundation, the average monthly premium for a Medicare Advantage plan was $25 in 2020, making it an affordable alternative to Original Medicare if you need extra coverage.

Call me to find a plan that works for you and covers all of the services you need.

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By Kat Tretina