Financial Planning

Avoid Surprises with Medicare  – What’s Not Covered

By January 2, 2019 No Comments

Today’s blog post is a guest post from Danielle K Roberts.

Some aspects of Medicare surprise new beneficiaries. All these surprises could be avoided if they had the right information well before they turn 65.

So, we’re going to let you in on a little secret: Medicare doesn’t cover everything.

Don’t get me wrong, it certainly covers a lot – around 80% of your healthcare costs. However, the fact that it doesn’t cover 100% of our healthcare costs in retirement often upsets people around the time of their enrollment.  What’s more, there are certain types of care that it doesn’t cover at all.

Knowing what Original Medicare doesn’t cover will help you be better prepared for your enrollment ahead of time.

Items and Services Not Covered by Original Medicare

There is a handful of items and services that Original Medicare doesn’t cover. They are as follows:

  • Routine dental care
  • Routine vision care
  • Hearing aids and the exams needed for them
  • Cosmetic surgery
  • Foreign travel care
  • Acupuncture
  • Routine foot care
  • Long-term care
  • Prescription drugs

Back in 2010, however, Medicare began covering multiple preventive care services that it had not covered prior to that time, such as annual physicals.

It’s important to note that while Medicare doesn’t cover certain routine care items, it does provide for preventive care. Routine care is care that happens on a regular basis, such as dental care that normally happens more than once a year. Preventive care is care that usually occurs no more than once a year.

Special Circumstances

There are some situations where exceptions are made to the list of items that Medicare doesn’t generally cover.

Cosmetic surgery is a good example of this. For example, a breast reconstruction with prosthesis can be covered if the beneficiary had a mastectomy. Eyeglasses are another example. They are generally not covered; however, if you have just had a cataract surgery, Medicare will pay for a set of basic lenses and frames after the surgery.

Another item that could be covered due to special circumstances is foreign travel emergency care. The key word there is emergency. Usually, in order for Medicare to cover your care while in a foreign country, you need to be at risk of loss of life or limb. However, there are three specific cases where Medicare might cover your inpatient hospital stay, doctor services, ambulance services, or dialysis.

  • When you are in the United States and an emergency occurs, but a foreign hospital is closer than an American hospital.
  • When you are traveling from one state to another through Canada by the most direct route, and an emergency occurs, but a Canadian hospital is closer than an American hospital.
  • If you live in the United States, but a foreign hospital is closer to you than an American hospital, Medicare may cover you even if it’s not an emergency.

So, as you can see, special circumstances can allow coverage for some of the items listed above. For the other items and for the 20% of your care that Original Medicare doesn’t cover, you can opt to enroll in a Medigap plan or Medicare Advantage plan.

How Supplemental Medicare Plans Can Help

Medicare insurance plans are optional plans you can enroll in to add coverage and/or benefits to your Original Medicare. There are three types of plans available today. These are Medigap plans, Medicare Advantage plans, and Medicare Part D plans.

Medicare supplement plans pay after Medicare to help fill in the gaps by covering deductibles, copays, and coinsurance (that other 20%) costs that you would normally have paid. There are several plans that include a foreign travel emergency benefit.

Part D drug plans are optional coverage you can purchase to help defray the costs of your retail outpatient prescription drugs.

Medicare Advantage plans are private insurance plans through which you can get your Part A and B benefits (instead of using Original Medicare).

These plans can also incorporate some extras that Original Medicare doesn’t cover, such as dental, vision, hearing, foreign travel, and foot care. The rule of thumb with Medicare Advantage plans is that they are required to cover at least what Original Medicare covers. They can, however, cover more if the carrier wishes. These extra benefits are one of the reasons about one-third of beneficiaries choose to enroll in a Medicare Advantage plan.

Be in The Know

Medicare is constantly adjusting. Since Medicare was originally established back in 1965, a great amount of changes has been made. That’s why it’s important to stay up to date on all the latest Medicare guidelines so you can avoid surprises and be well prepared about your potential future costs for healthcare in retirement.

Danielle K. Roberts is a Medicare insurance expert and co-founder at Boomer Benefits where she and her team help baby boomers find suitable Medicare supplement coverage. You can reach them on Facebook or tweet them on Twitter.

Michael Garry

Author Michael Garry

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