Original Medicare, also known as Medicare Parts A and B, provides seniors with health insurance coverage for a wide range of medical services. However, there are some pretty significant gaps in what Original Medicare covers.
Understanding exactly what isn’t included can help you plan ahead and figure out how to supplement your coverage. Here are 6 important things that Medicare does not cover that you may need to budget for in retirement.
1. Routine Dental Care
One major gap in Original Medicare is coverage for dental services. Medicare does not cover routine dental cleanings, fillings, tooth extractions, dentures, or other oral health services.
The only dental-related coverage Medicare provides is for certain medical procedures like jaw reconstruction or oral examinations prior to kidney transplants. Purely cosmetic dental procedures are also not covered.
Some Medicare Advantage Plans may offer additional dental benefits not covered by Original Medicare, but these vary by plan. To help pay for services like cleanings, crowns, and root canals, you’ll likely need to purchase a separate dental insurance policy or dental discount plan.
2. Routine Vision Care and Eyeglasses
Routine vision care, including eye exams and prescription eyeglasses or contacts, is also not covered by Original Medicare. An annual eye exam to check for medical conditions like glaucoma or cataracts may be covered, but routine vision screenings for glasses or contacts are generally excluded.
Again, some Medicare Advantage Plans will cover vision benefits like a yearly eye exam allowance and discounts or coverage for eyeglasses. But for those with Original Medicare, routine vision expenses will likely be out-of-pocket costs. Private vision insurance plans can help fill the coverage gap.
3. Hearing Aids
Original Medicare does not cover any costs associated with hearing aids or exams for fitting them. The only hearing-related services covered are diagnostic exams to check if you have a medical condition causing hearing loss.
Hearing aids and fitting exams can be quite expensive without insurance, often $2,000 – $4,000 or more per ear. Some Medicare Advantage Plans offer partial coverage for hearing aids, but benefits vary significantly. To save on these costs, private insurance or discount programs may provide the most coverage.
4. Most Prescription Drug Coverage
Medicare Part B covers a limited number of doctor-administered prescription medications, like certain chemotherapy drugs. But when it comes to pharmacy prescriptions you pick up yourself, Medicare may or does not provide coverage.
Outpatient retail prescription drugs are covered under services Medicare Part D Plans, which are sold by private insurance companies. To get drug coverage, you must enroll in a standalone Part D Plan in addition to your Original Medicare benefits.
Nearly all Medicare Advantage Plans include built-in Part D drug coverage, but it is not part of Original Medicare. Make sure you choose a Part D Plan or Advantage Plan that covers your medication needs.
5. Long-Term Care
Long-term custodial care like help with activities of daily living is not covered by Medicare. This type of extended, non-skilled care is often provided in nursing homes, assisted living facilities, or at home with aides. Medicare will only pay for medically-necessary skilled nursing or rehab services following a hospital stay, and only for a limited time.
Custodial long-term care costs can run thousands of dollars per month. Options to cover these expenses include long-term care insurance, Medicaid coverage for those with low assets, or paying out-of-pocket. Planning ahead for long-term care is key, as it is not included in Original Medicare.
One more gap in Medicare coverage worth noting is routine foot care like trimming toenails or corns and calluses. Medicare generally does not cover routine foot care for non-medical reasons like hygiene and appearance.
However, Medicare may cover foot exams and treatment if you have a medical condition affecting your feet, like diabetic neuropathy or peripheral artery disease. Routine foot care costs may also be covered if you have an illness that impacts your ability to properly care for your feet on your own. But for generally healthy seniors, routine podiatry will not be covered.
How to Fill in the Gaps in Original Medicare Cover
As you can see, Original Medicare leaves a lot of common healthcare services uncovered. How can you make sure these routine expenses don’t break the bank in retirement? Here are a few options:
- Medicare Advantage – These Medicare Part C Plans often include extra benefits like dental, vision, hearing, and drug coverage. Premiums vary.
- Medigap – Medicare Supplement Insurance can cover certain out-of-pocket costs, but not the excluded services above.
- Separate insurance – Individual dental, vision, hearing, and drug plans can provide additional coverage.
- Secondary insurance – Keep coverage from a previous employer to use with Medicare.
- Carefully budget – If no supplemental coverage, budget for routine out-of-pocket expenses.
Planning ahead and understanding exactly what Original Medicare doesn’t cover is key to limiting surprise healthcare costs in retirement. Talk to an insurance broker or financial advisor for help evaluating your Medicare Plan options.
Submitting Claims for Covered Services
For healthcare services that are covered under Medicare Part B, make sure you submit claims properly so they can be paid. Here are some tips:
- Double check that the service provided is covered under Part B specifically. See what Part B covers.
- Ask your doctor to submit the claim on your behalf. They are familiar with the process.
- If you submit yourself, use the proper CMS-1500 claim form.
- Include your Medicare number, date of service, doctor information, and service codes.
- Make photocopies for your records before mailing to Medicare.
Following up is key! If your Part B claim is denied, call Medicare to understand why and determine if you can appeal. Make sure services covered under Part B are billed properly so they can be paid.
Medicare Doesn’t Cover Everything – Plan Ahead
While Medicare provides extensive healthcare coverage in retirement, it does not cover everything. Be prepared for routine expenses like dental work, new glasses, hearing aids, and prescription drugs.
Take time to explore supplemental coverage options like Medigap or Medicare Advantage Plans. And budget carefully for the medical costs that Medicare will not cover. Planning ahead is crucial so you can access the healthcare services you need without financial stress or surprise bills down the road.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at American Entitlements a Call at (469) 814-0289. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
What is Medicare Part B?
Medicare Part B is a component of the Medicare program that helps cover medically necessary services and supplies, such as doctor’s visits, outpatient care, and preventive services.
What does Medicare Part B cover?
Medicare Part B covers a wide range of services, including doctor’s visits, outpatient care, preventive services, laboratory tests, and durable medical equipment.
What services are not covered by Medicare Part B?
Medicare part a and Part B does not cover certain services, such as routine dental care, routine eye exams, cover hearing aids, cosmetic surgery, and long-term care.
Does Medicare Part B cover prescription drugs?
No, Medicare Part B does not generally cover prescription drugs. However, some medications, such as those administered during an outpatient procedure, may be covered.
Can Medicare Part B cover cataract surgery?
Yes, Medicare Part B covers cataract surgery when it is deemed medically necessary.
Does Medicare Part B cover the cost of hearing aids?
No, Medicare Part B does not cover the cost of hearing aids. However, there may be other programs or insurance options that provide coverage for hearing aids.
Is long-term care covered by Medicare Part B?
No, Medicare Part B does not cover long-term care, such as inpatient hospital, nursing home care or assisted living facilities.
Does Medicare Part B cover routine eye exams?
No, Medicare Part A covers exams related to the diagnosis or treatment of certain eye conditions.
What is the Medicare Part B deductible?
The Medicare Part B deductible is the amount you must pay out of pocket before Medicare begins to pay for covered services. The deductible amount may change each year.
Can Medicare Part B cover prescription drugs?
No, Medicare Part B does not generally cover prescription drugs. However, there is Medicare Part D, which is a separate program that provides prescription drug coverage.