Medicare provides healthcare coverage to a staggering 65 million individuals and accounted for 3.9% of the United States' gross domestic product in 2021, amounting to a total of $868 billion. Despite this substantial financial commitment, many people mistakenly believe that Medicare covers all healthcare expenses for seniors and those with disabilities. Regrettably, this is not the case. Original Medicare, encompassing Parts A and B, offers coverage for specific services and procedures, but it leaves out common medical expenses such as dental, vision, and medical care outside the U.S.
Discovering that certain services are not covered can come as an unwelcome surprise. Understanding what is and isn't covered is crucial because it helps you budget for potential healthcare expenses both at the age of eligibility for Medicare, which is 65, and beyond.
To assist you in preparing financially, let's explore some of the things that Medicare does not cover:
Prescription drugs: Original Medicare does not include prescription coverage, but you can add it through Part D for an extra cost. Some Medicare Advantage plans also cover prescriptions.
Hearing: Original Medicare does not cover hearing exams or hearing aids. However, Medicare Advantage plans may provide partial coverage for these items to help mitigate the cost. An exception exists: Part B may cover diagnostic hearing tests or balance exams if recommended by your doctor.
Deductibles and co-pays: Medicare Parts A and B have deductibles that participants must cover. Part A, which covers hospital stays, has a deductible of $1,600 for each hospital stay in 2023. For hospital stays exceeding 60 days, additional costs may apply. Part B, covering doctor's visits and outpatient services, includes a monthly premium and generally covers 80% of costs, leaving 20% and an annual deductible to be paid by the beneficiary.
Long-term or custodial care: Medicare does not cover extended long-term care or custodial care. This includes daily living activities such as bathing and dressing. Consider long-term care insurance as part of your retirement plan.
Dental: Most dental services, including cleanings, fillings, and dentures, are not covered by Medicare. Some Medicare Advantage plans offer dental coverage, but it may be limited to preventive and diagnostic services.
Vision: Similar to dental and hearing, Original Medicare typically does not cover eyeglasses, eye exams, or other vision services. Exceptions exist for annual eye exams related to diabetes and corrective lenses following specific cataract surgeries.
Overseas medical care: Medicare generally does not cover medical care received while traveling internationally. Some Medicare Advantage plans offer international travel coverage, but it's essential to understand the specifics.
Routine foot care: Except for diabetes-related lower leg nerve damage or injuries, Medicare does not cover routine foot care.
Chiropractic or acupuncture services: Coverage for chiropractic services is limited to specific circumstances. Acupuncture is only covered for chronic low back pain under certain conditions.
Cosmetic surgery: Medicare may not cover cosmetic surgical procedures unless they result from accidental injury or improve the function of a malformed body part.
Hospital room amenities: While Medicare generally covers hospital stays, it may not cover amenities like a private room or personal items during your stay.
Final Words:
With Medicare covering an average three-day hospital stay of around $30,000, it is a significant help for many individuals dealing with medical issues. However, it's essential to be prepared for the aspects it doesn't cover and consider additional sources of funding for unexpected costs, such as starting a high-yield savings account. When exploring Medicare options, research all available Medicare Advantage plans to ensure comprehensive coverage for your needs in retirement.
About Tia:
Tia L. Vango brings more than twenty years of experience, meeting her clients right at their kitchen table. She is a dynamic business owner and visionary leader. In her capacity as the Director of Operations at Elite Medicare Specialists LLC, Tia has solidified her position as a trusted advisor to numerous individual clients and a valuable mentor to her team. Her primary focus at Elite Medicare is on business growth opportunities and agent development. Tia is committed to ensuring informative and productive interactions with everyone who engages with an Elite Medicare Specialist.
"I firmly believe that people are empowered when equipped with the knowledge needed for sound decision-making. My aspiration is to impart that empowerment to each person I engage with, every time we interact." - Tia Garner Vango
Tia holds licenses as an Insurance Agent and Qualified Financial Advisor, serving clients in Delaware, Maryland, North Carolina, Tennessee, Texas, and Virginia. Beyond her Medicare certification, she possesses certifications in Long Term Care and Retirement Income Planning. During her leisure time, Tia finds joy in hitting the open road on her motorcycle. She is also a dedicated wife and mother.
Advisory Roles:
Medicare
Long Term Care
Life Insurance
Income and Asset Protection
Retirement Planning