Wednesday, August 1, 2018

What Medicare Does Not Cover

Most adults in the United States over the age of 65 are covered by Medicare.  American workers paid premiums in advance into the program during our working years.  We did this so our premiums for basic Medicare insurance coverage after retirement would be affordable.

Once we sign up for our basic Medicare insurance, we can also add a supplement, sometimes called a Medigap policy, through a private insurance carrier; or, we can choose a private Medicare Advantage plan, like Kaiser Permanente or SCAN, to handle our Medicare insurance for us.  Adding a private insurance supplement or using a Medicare Advantage plan will assure us that our out-of-pocket costs will be reduced.  However, many people assume all their future medical expenses will be completely covered after they reach the age of 65.  Unfortunately, they are often shocked to discover they will still have to pay out-of-pocket for some important expenses, including premiums, co-pays, deductibles and a number of health needs which are NOT covered by Medicare.

You Should be Prepared for Uncovered Medical Bills

It is important for everyone to realize that basic Medicare does not cover a number of important conditions which could affect almost everyone during the last few decades of life.  By knowing what is not usually covered, you can search for policies which will help fill in some of the gaps or you may want to put aside extra money for your future medical costs.

Hearing Aids Are Usually Not Covered

Basic Medicare and most Medigap plans do not cover normal hearing tests or hearing aids.

Solutions:  Look for a Medicare Advantage plan which includes hearing care, sometimes for an additional premium.  You might be able to sign up for a discount plan for hearing aids.  There are also some special discounts for low income people.  Within a few years, it may be possible to buy certain types of hearing aids without a prescription, due to new legislation recently passed by Congress.  This could bring down their cost.  However, be prepared for the fact that hearing aids can cost thousands of dollars.

You May Want a Dental Care Supplement

Basic Medicare and most Medigap plans do not cover either routine check-ups or major dental work such as root canals or dentures.  If you lose teeth as you age and need dentures or dental implants, these items are not covered, either, and they can be quite expensive.

Solutions:  You may find a Medicare Advantage plan which offers reduced cost dental care, either as part of their basic plan or for an extra premium.  It is also possible to purchase an individual dental insurance plan or private dental discount plan.  You may also be able to get low-cost dental care from a local dental school.  It is important that you NOT wait until you actually have an abscessed tooth or other serious dental problem before you look for dental insurance.  Find a policy as soon as you start Medicare and expect to have out-of-pocket expenses, even with the dental insurance.

You Will Need a Vision Care Supplement

Medicare, combined with most Medigap plans, will cover certain types of eye diseases or damage such as cataracts.  However, those plans do not cover the cost of routine eye exams or corrective lenses such as glasses and contact lenses.  In addition, they often only cover the least expensive type of replacement lens after cataract surgery.  If you want the more advanced lenses, you could be expected to pay thousands of dollars out-of-pocket.

Solutions:  Some Medicare Advantage plans do cover a portion of your vision care costs, usually for an extra premium.  If you need your vision corrected or anticipate vision problems, it may be worth it to purchase a vision insurance policy to help control your out-of-pocket costs.  However, no matter what plan you have, you should still expect to pay out-of-pocket for certain expenses, such as contact lenses, eyeglasses, co-pays and deductibles.

Ask About Podiatry Coverage under Your Supplement or Advantage Plan

Medicare does not cover routine medical care for feet, such as having a callus removed. However, it will cover more serious foot problems.

Solutions:  If you have foot problems and need the care of a podiatrist, try to find a Medigap or Medicare Advantage policy which will cover your costs.  Otherwise, put aside extra money to cover your care.

Plastic Surgery for Cosmetic Reasons is Not Covered

Are you hoping to get a tummy tuck or facelift as you age?  Medicare will not generally cover those expenses.  However, if your eyelids sag so much that it affects your vision, Medicare may cover an eyelid lift.

Solutions:  If you believe you are going to want cosmetic surgery as you age, you will need to put aside the money to cover the cost.  You may also want to consider getting the treatments you want at a local medical school.  They will still charge you, but less than an established board certified plastic surgeon in private practice.

Emergency Medical Care Outside the U.S. is Generally Not Covered by Medicare

Basic Medicare and most Medicare Advantage plans do not offer coverage for beneficiaries when they are outside the U.S.

Solutions:  If you plan to retire outside the United States, as hundreds of thousands of other Americans have done, your best bet is to buy a health insurance plan in the country where you will be living.  If you travel back and forth between the U.S. and other countries, you may consider one of two options.  First, you could look for a Medigap policy which will cover you whether you are in the U.S. or outside the country.  The other option is to have a Medicare plan which will cover you while you are in the U.S. and a health insurance plan in the country where you spend the most time.  If you can afford it, this would give you the widest range of choices for care.

If you live in the United States and only need coverage when you travel on vacation, some Medigap plans cover overseas medical costs.  However, many frequent travelers purchase travel insurance policies which cover basic healthcare expenses while you are traveling.  You may also want to consider "medevac" insurance which will cover either the cost of transportation to a medical facility overseas or a return trip home in the event of a medical emergency.

Long-term Assisted Living and Nursing Home Care is Not Covered

Neither Medicare, Medicare Advantage plans, nor Medigap plans will cover the cost of permanently living in an assisted living facility or nursing home.  However, Medicare will cover the cost of a temporary stay in a rehab facility while you recover from surgery or a serious illness.

Solutions:  Everyone needs to have a plan for how they will be cared for, should they become seriously ill, too frail to live on their own, or develop dementia.  You may have an adult child who is willing and able to care for you during the final years of your life.  You may also want to purchase long-term care insurance to cover the cost of assisted living or the expense of having a home healthcare aide take care of you in your home.  If you have a large retirement income, you may be able to cover these expenses without insurance.  On the other hand, if you have a low income and few assets, Medicaid (a separate program from Medicare) often pays the cost of long-term care.  For veterans and their spouses, there are also benefits available to pay a portion of their long-term care.  However you decide to handle this issue, it is important you have a plan in place long before you need it.  The younger you are when you purchase long-term care insurance, the less expensive it will be.  In addition, once you have a serious health problem, you may not be qualified to purchase long-term care insurance at any price.

The bottom line is that everyone needs to know what will be covered by Medicare and they should either have a Medigap or Medicare Advantage plan to maximize their insurance coverage.  Once you know which uncovered needs you have, you should decide how those expenses will be handled as you age.  Your medical expenses could become quite high, even if you have Medicare and a supplement.  The more money you can save to cover these expenses, the better prepared you will be when you have large medical bills.

If you are interested in learning more about Medicare, Social Security, financial planning, common medical issues as you age, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

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2 comments:

  1. There's so much important information in this post. My husband signed up for long term health care but had not had the required physical when he had a heart attack. That event prevented him from being able to get long term health care coverage with any company. It's important to take care of these kinds of arrangements while you are younger to insure your life in retirement.

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    1. Thank you so much for your comments. Everyone should begin thinking about their retirement when they are as young as possible. So many middle age people do not know what to expect. Once they realize they need to get insurance to protect them in different situations, it can be too late.

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