When you turn 65, you probably have a good idea of what health insurance does and doesn’t cover. But Medicare is a different beast, and there are some surprising things that don’t fall under the Medicare umbrella.
Medicare is the federal government’s health insurance coverage for people 65 and older and other people living with disabilities and certain chronic conditions. Here are seven things Medicare doesn’t cover:
1. Deductibles and coinsurance
If you opt for Original Medicare, both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) require out-of-pocket costs in the form of deductibles and coinsurance. If you have medical needs, this can be expensive and there is no out-of-pocket limit on Original Medicare spending.
People are also reading…
“Many people with traditional Medicare get a Medigap plan to help cover those costs and make their out-of-pocket costs more predictable,” says Gretchen Jacobson, vice president of Medicare for The Commonwealth Fund, a private foundation with a mission to promote a system high performance health.
If you join a Medicare Advantage plan, offered by private insurance companies that contract with the federal government, you’ll also be responsible for any required deductibles, copays, or coinsurance when you seek care. Although there is an out-of-pocket maximum for Medicare Advantage, that limit may reach $7,550 in 2022.
2. Routine dental care
Although Medicare Part A covers some dental services you may receive as part of a hospital stay, basic dental care, such as cleanings, X-rays, and fillings, is not covered. If you want coverage, you’ll need to purchase a separate dental policy.
You may be able to get some coverage by buying a Medicare Advantage plan with dental benefits. “But those benefits may be limited, or Medicare Advantage plans may ask you to pay more for those benefits,” says Lina Walker, vice president for health insurance at AARP’s Public Policy Institute.
3. Eye exams
Medicare doesn’t cover eye exams for glasses or contact lenses, or the glasses or contact lenses themselves. Medicare Part B covers one pair of eyeglasses or contact lenses if you have cataract surgery. (After the $233 Part B deductible in 2022, you’ll pay 20% of the costs.)
Medicare also does not cover hearing aids or tests required for hearing aids. While there is some language in the Build Back Better Act to add hearing aid coverage to Medicare, the law has not been passed by Congress. Medicare covers diagnostic hearing exams if your doctor thinks you need them.
5. Prescription drugs
Original Medicare Parts A and B do not offer prescription drug coverage. If you want prescription drug coverage, you must buy a Medicare Part D plan from a private insurance company or get prescription drug coverage from a Medicare Advantage plan that includes it.
Medicare drug coverage is optional, but if you choose to drop it and don’t have other creditable drug coverage, you’ll pay a late enrollment penalty if you decide to join in the future. You’ll pay this penalty as long as you have Medicare drug coverage, so it’s worth making sure you get and keep qualifying coverage once you’re eligible.
6. Long-term care
A person who turns 65 today has a 7 in 10 chance of needing long-term care at some point in the future, according to the Department of Health and Human Services, and it can be a big expense. But Medicare doesn’t cover long-term care if it’s the only care you need.
“This is an area where there could be some confusion, because people have heard that Medicare covers nursing services,” says Walker. Medicare covers skilled nursing facility care if your doctor recommends it after a qualifying three-day hospital stay. Under these circumstances, Medicare covers the first 100 days of care along with a daily coinsurance. After that, you are responsible for all costs.
Medicare Advantage plans may offer some additional limited benefits. “Some Medicare Advantage plans do provide help at home, but right now it’s pretty limited coverage and relatively few plans do,” says Jacobson.
7. Medical care abroad
If you are outside the US and certain US territories, Medicare does not cover medical care and supplies, except under very specific circumstances. (For example, if you are passing through Canada between Alaska and another state when you have a medical emergency, and a Canadian hospital is closer than one in the US, Medicare may cover your care.) coverage to travel or buy insurance in the country where you live.
This is a key point if you plan to move out of the country. If you ever change your mind and want to return to the US and re-enroll in Medicare, you may be subject to Part B penalties. to Medicare,” says Walker.