While Original Medicare, and especially Medicare Advantage, comes with a number of great and low-cost benefits, it does not cover all health care services that you may need after you turn 65.
Keep in mind that the following list includes things that Original Medicare and the majority of Medicare Advantage plans do not cover. To make sure you understand the limits of Medicare, you should look at this list. If the list includes a service you think you need, we offer a solution.
Care you receive abroad
Original Medicare will not pay for any health care services you receive while traveling abroad. Also, supplemental Medicare prescription drug plans purchased by Original Medicare recipients do not cover prescriptions outside of the United States.
What you can do: If you are planning to travel abroad, you may want to look into a Medigap plan from a private insurer. Some may offer coverage if you are going overseas. If you can’t find one, you should consider travel insurance that also covers health care services.
Long-term care
Original Medicare and Medicare Advantage are great for regular doctor’s visits and for any procedures you may need, like surgeries or other therapies. However, they do not cover long-term care costs that can mount quickly. Long-term care is defined as medical and non-medical services for people who cannot perform basic daily tasks like dressing or bathing on their own. People who need long-term care can hire someone to come into their home, or be cared for at an assisted living facility or nursing home. This type of care is typically not dispensed in hospitals and it can be extremely costly.
Consider the following long-term care scenarios and their average costs:
- In-home health aide: $4,576 per month
- Assisted living facility: $4,300 per month
- Nursing home semi-private room: $7,756 per month
- Nursing home private room: $8,821 per month
What you can do: One option is to secure long-term care insurance. That should be done as early as possible as the premiums grow exponentially as we age. If you have certain health conditions, it may be out of reach.
Dental care
Original Medicare does not cover dental care like cleanings, fillings and tooth extractions. Enrollees will have to pay those costs out of pocket.
What you can do: Some, but not all, Medicare Advantage plans cover preventative dental care like cleanings and routine exams. Some cover comprehensive care as well, such as crowns and extractions. With most plans, preventive care does not have a maximum yearly amount.
Hearing aids
As people age, many experience hearing loss. While Original Medicare would pay for treatment, it does not cover hearing aids. You will have to pay 100% of the cost yourself. That said, it usually covers 80% of diagnostic hearing exams to determine if you need treatment.
What you can do: The majority of major insurers that offer Medicare Advantage plans have at least one plan that covers hearing aids.
Routine vision care
Original Medicare typically neither covers exams for eyeglasses or contacts nor the cost of glasses or contact lenses. Enrollees will have to pay for those themselves. However, it does cover screening for glaucoma, cataracts or macular degeneration. It will also cover eye exams for patients with diabetes, as well as treatment.
What you can do: Certain Medicare Advantage plans cover eyeglasses, intraocular (artificial) lenses and contact lenses. If you need corrective lenses, during your next open enrollment you may want to look for a plan that offers this coverage.
If you are looking to understand what Medicare is and all of its parts, visit our YouTube Channel. We break down all the parts of Medicare in an easy format to understand.
*If you have an insurance need, we have a solution. We provide solutions for home & auto, health and Medicare insurance, life & dental coverage, employee benefits and commercial insurance. Give us a call at 803-286-1161.
