Vincent Thrasher
Founder at - over65 insurance optionsVincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior...Read more
Medicare is a government-funded health insurance program that provides coverage for millions of Americans aged 65 and above. However, as comprehensive as the coverage may seem, there are still some gaps in the program. In this article, we’ll explore what Medicare Parts A and B do not cover, and what you can do to fill those gaps and protect yourself.
While Medicare Parts A and B cover a wide range of medical services, they do not cover everything. For example, routine dental, vision, and hearing care are not covered under Medicare, nor are prescription drugs. As you’ll see, it’s essential to understand what is and isn’t covered by Medicare so that you can plan accordingly and make informed decisions about your healthcare.
Original Medicare (Part A and Part B) does not cover everything. It does not cover most dental care, eye exams related to prescribing glasses, dentures, cosmetic surgery, acupuncture, hearing aids, and long-term care. However, you can get coverage for some of these services through a Medicare Advantage plan or a separate Medicare Part D plan.
What Does Medicare A and B Not Cover?
Medicare is a federal health insurance program that covers a wide range of medical expenses for people aged 65 and older, as well as younger individuals with specific disabilities. While Medicare covers a significant amount of healthcare costs, it does not cover everything. Understanding what Medicare does not cover is essential to avoid unexpected medical bills. This article will detail what Medicare A and B do not cover.
1. Long-Term Care
Medicare does not cover long-term care. Long-term care refers to the medical care and support services provided to individuals who are unable to perform daily living activities on their own. Medicare only covers short-term care that is medically necessary to help a person recover from an illness or injury. Long-term care can be expensive and is usually paid for out of pocket or through Medicaid.
2. Dental Care
Medicare does not cover routine dental care, including check-ups, cleanings, and fillings. Some Medicare Advantage plans may offer dental coverage, but it is not included in the standard Medicare plans. However, Medicare may cover dental services that are deemed medically necessary, such as a dental exam before a heart surgery.
3. Eye Exams and Glasses
Medicare does not cover routine eye exams, glasses, or contact lenses. Medicare only covers eye exams that are related to specific medical conditions, such as cataracts or macular degeneration. If you need vision correction, you will need to pay for it out of pocket or through a separate vision insurance plan.
4. Hearing Aids
Medicare does not cover hearing aids or exams for fitting hearing aids. If you need a hearing aid, you will need to pay for it out of pocket or through a separate hearing insurance plan. Some Medicare Advantage plans may offer hearing aid coverage, but it is not included in the standard Medicare plans.
5. Cosmetic Procedures
Medicare does not cover cosmetic procedures, such as facelifts, tummy tucks, or breast implants. These procedures are considered elective and are not necessary for a person’s health. If you want to have a cosmetic procedure, you will need to pay for it out of pocket.
6. Prescription Drugs
Medicare Part A and B do not cover most prescription drugs. You can purchase a separate Part D plan to cover prescription drugs or enroll in a Medicare Advantage plan that includes prescription drug coverage. However, even with these plans, you may still have to pay a portion of the cost.
7. Foreign Travel
Medicare does not cover medical expenses incurred while traveling outside of the United States. If you plan to travel abroad, you may want to purchase travel insurance that includes medical coverage. Some Medicare Advantage plans may offer limited coverage for foreign travel emergencies, but it is not included in the standard Medicare plans.
8. Home Care
Medicare does not cover 24-hour home care. Medicare only covers home healthcare services that are medically necessary and provided by a Medicare-certified home healthcare agency. If you need non-medical assistance with daily living activities, such as bathing or dressing, you will need to pay for it out of pocket or through a separate long-term care insurance plan.
9. Acupuncture
Medicare does not cover acupuncture, even if it is deemed medically necessary. Acupuncture is considered an alternative therapy and is not covered by Medicare. If you want to receive acupuncture treatment, you will need to pay for it out of pocket.
10. Routine Foot Care
Medicare does not cover routine foot care, such as nail trimming or callus removal. Medicare only covers foot care that is related to a specific medical condition, such as diabetes. If you need routine foot care, you will need to pay for it out of pocket or through a separate insurance plan.
In conclusion, while Medicare covers a significant amount of healthcare costs, it is important to understand what it does not cover to avoid unexpected medical bills. Long-term care, dental care, eye exams, glasses, hearing aids, cosmetic procedures, prescription drugs, foreign travel, home care, acupuncture, and routine foot care are not covered by Medicare A and B. It is essential to plan ahead and consider purchasing additional insurance to cover these services if needed.
Frequently Asked Questions
What medical expenses are not covered by Medicare Parts A and B?
Medicare Parts A and B, also known as Original Medicare, cover a wide range of medical services and supplies, but there are some exceptions. Medicare does not cover long-term care, such as nursing homes or assisted living facilities. It also does not cover most dental care, including dentures, routine eye exams, eyeglasses, hearing aids, and cosmetic surgery. However, some Medicare Advantage plans and private insurance policies may offer coverage for these services.
Additionally, Medicare does not cover prescription drugs under Part A and B. You must enroll in a separate Part D plan to receive coverage for prescription medications. Certain medical services, such as acupuncture and chiropractic care, are also not covered by Original Medicare, although some Medicare Advantage plans may offer coverage for these services.
What is the cost-sharing for Medicare Parts A and B?
Medicare Part A, which covers hospital stays, is generally free for most enrollees who have paid enough Medicare taxes during their working years. However, there are some cost-sharing requirements, such as a deductible for each benefit period and coinsurance for longer hospital stays.
Medicare Part B, which covers doctor visits and other outpatient services, requires a monthly premium. In 2021, the standard monthly premium is $148.50, although higher-income individuals may pay more. Part B also has an annual deductible, as well as coinsurance or copayments for many services. Some Medicare Advantage plans may offer lower cost-sharing requirements, such as lower copayments or no deductibles, but they may also have higher monthly premiums.
Does Medicare cover home health care?
Medicare does cover home health care services for individuals who are homebound and require intermittent skilled nursing care or therapy services. This may include services such as physical therapy, occupational therapy, speech-language pathology, and skilled nursing care. Medicare also covers medical social services and home health aide services, but only if they are related to your care.
However, Medicare does not cover 24-hour-a-day care at home, homemaker services, or personal care services, such as bathing and dressing. These services may be covered by Medicaid or other state programs, or you may need to pay for them out of pocket.
Can I receive coverage for medical services received overseas?
Generally, Medicare does not cover medical services received outside of the United States, except in very limited circumstances. However, some Medicare Advantage plans may offer coverage for emergency medical care received overseas. You should check with your plan to see what types of coverage are available if you plan to travel outside of the United States.
If you have a Medigap policy, some plans may offer limited coverage for medical services received outside of the United States. This coverage is generally limited to emergency care, and you may need to pay a deductible or coinsurance for these services.
What is the Medicare Part D coverage gap?
The Medicare Part D coverage gap, also known as the “donut hole,” is a temporary limit on prescription drug coverage. Once you and your plan have spent a certain amount on covered drugs, you will enter the coverage gap and be responsible for a larger portion of your drug costs. However, the coverage gap is gradually being phased out, and by 2021, you will only be responsible for 25% of the cost of both brand-name and generic drugs while in the gap. Once you have spent a certain amount out of pocket, you will exit the coverage gap and receive catastrophic coverage, which covers most of your drug costs for the rest of the year.
In conclusion, Medicare is a valuable program that provides healthcare coverage for millions of Americans. However, it’s important to understand that Medicare A and B do not cover everything. There are gaps in coverage that beneficiaries should be aware of in order to avoid unexpected medical bills.
One of the biggest gaps in coverage is long-term care. While Medicare may cover some skilled nursing care for a limited time, it does not cover custodial care or long-term care in a nursing home. This can be a significant financial burden for seniors and their families.
In addition, Medicare A and B do not cover some preventive services, such as dental care, vision care, and hearing aids. While some Medicare Advantage plans may offer additional coverage for these services, beneficiaries should be prepared to pay out of pocket for these expenses.
Overall, understanding what Medicare does and does not cover is essential for making informed healthcare decisions. By knowing the gaps in coverage, beneficiaries can take steps to protect their health and finances.
Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior insurance, encompassing Medicare, Medigap, long-term care insurance, life insurance, and dental, vision, and hearing insurance. Vincent's unwavering passion for guiding seniors through the intricate insurance landscape and crafting customized solutions to address their individual needs has earned Over65InsuranceOptions an esteemed reputation as a dependable ally for seniors nationwide.
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