What Medicare Doesn’t Cover

Retirement, Income, Tax & Estate Planning.

What Medicare Doesn’t Cover

October 22, 2020 Medicare Newsletter 0

I get so many questions on Medicare and, having been on it for a few years, I’m learning the ropes. If it’s a government program then you know it will be complicated and confusing.

Kiplinger recently put out a pretty good column explaining the seven things Medicare doesn’t cover. For those not yet on Medicare, I thought this might be a timely bit of information.

Medicare Part A and Part B don’t cover everything. There are some significant gaps in what they will pay for. Let’s take a look:

  1. Prescription Drugs – Since Medicare doesn’t pay for outpatient drugs, you need to either buy a separate Part D prescription plan or enroll in a Medicare Advantage plan that includes prescription drugs. Each year you can change your Part D plan if other plans offer better coverage for the medications you take.
  2. Long-Term Care (LTC) – With skilled care in a nursing home running close to $150,000 per year, all you might get Medicare to pay for is 20 or 30 days of post-hospital rehabilitation. Otherwise, you’re on the hook for LTC if you don’t have an LTC or life insurance policy to help with the costs.
  3. Deductibles and Co-Pays – Part A covers hospital stays, Part B covers doctors’ services and outpatient care. But you’re going to be on the hook for deductibles & co-pays. And those can add up quickly if there’s a prolonged hospital or rehabilitation stay.
  4. Most Dental Care – For the majority of dental proceedings you consider “routine”, you’ll need an aftermarket dental plan, one of a select few Medicare Advantage plans that includes dental, or you’ll need to have built up the funds in a health savings account before filing for Medicare.
  5. Routine Vision Care – With the exception of post-cataract surgery eyeglasses and annual eye exams for diabetics, Medicare doesn’t touch vision. Much like dental, if you want vision coverage, you’ll need an aftermarket plan, a built-up HSA, or a specific Medicare Advantage plan.
  6. Hearing Aids – Hearing aids can run you as much as $3,250/year, unless you have a specific Medicare Advantage plan that covers hearing health, or one of a few discount programs.
  7. Overseas Medical Care – Base Medicare isn’t going to cover medical care overseas, but Medigap plans C through G, M, and N will cover 80% with a lifetime limit of $50,000. Otherwise, you’ll need a specific Medicare Advantage plan or you’ll need to purchase travel insurance.

Any questions, or need more info? You can always give me a call at 215-657-9200 or visit medicare.gov/coverage.