Do You Know What’s NOT Covered by Medicare?

Most individuals can put in for Medicare three months before the month they turn 65. There are two parts to it: unhelpfully labeled Part A and Part B. Essentially, Part A deals mostly with inpatient care  (whether in hospital, skilled nursing facilities, or hospice), and Part B serves as medical insurance for outpatient care and preventive services, including doctors’ visits and some medical equipment and supplies.

Unfortunately, there are some things Medicare does not cover. In its recent article, Kiplinger set out seven important categories where Medicare falls short. However, individuals are not left without options for these gaps, they simply have to know where to patch and bridge.

First, prescription drugs. Medicare doesn’t cover outpatient prescription drugs. You can pay for a Medicare Advantage plan or a Part D prescription-drug policy to cover those costs. You can sign up for that coverage when you first enroll in Medicare or when you lose other drug coverage. If you want to swap policies, enrollment season is in the fall each year.

Second, long-term care. Medicare will cover some skilled nursing services, but not custodial care (which includes bathing, dressing, and other parts of daily life). Long-term care insurance or a life insurance policy bundled with long-term care insurance can fill the gap here. These policies are cheaper the younger you are when you take them out.

Third, deductibles and co-pays. Medicare has its own set of deductibles like other healthcare plans you may have had in the past. In 2018, the Part A deductible is $1,340, and long hospital stays require that you pay a portion of the costs. (For days 61-90, $335/day; after that $670/day.) Even with those costs, coverage for hospital stays past the 90-day mark are limited to 60, and referred to as “lifetime reserve days.” Once your lifetime reserve days are used up, the cost per day after 90 days is paid entirely by you.

In 2018, Part B has a $183 deductible, but once you’ve paid the deductible Part B will only cover 80% of costs for covered doctors’ visits, x-rays, and medical tests. As with prescription drugs, a Medicare Advantage plan can fill in here, as can a Medigap policy. Note that insurers can’t refuse your application or hike up the price for you if you buy a Medigap policy within six months of signing up for Part B.

Fourth, most dental care. The average preventative care of dentistry is not covered by Medicare. Cleanings, fillings, dentures, or most tooth extractions won’t be covered. Again, Medicare Advantage plans can cover some (cleanings and x-rays) but not all. They are often capped for annual coverage of about $1,500. Outside dental insurance policy plans are also available.

Fifth, basic vision care. Medicare usually doesn’t pay for glasses or routine eye checkups. It will pay for an annual eye exam if you have diabetes or it’s related to vision correction after cataract surgery. Medicare Advantage plans sometimes provide vision coverage, or a separate supplemental policy will cover it, sometimes in a bundle with dental.

Sixth, hearing aids. Routine hearing exams and hearing aids are not covered by Medicare. You can lower the costs through some Medicare Advantage plans or through discount programs. If you have money left over in a healthcare savings account from before you started using Medicare, that can be used for hearing aids.

Seventh, medical care overseas. When you travel overseas, Medicare usually won’t cover any expenses you have. There is a very narrow exception for when you’re onboard a cruise ship within six hours of a U.S. port, but it’s not something to rely on. There are Medigap plans that will cover 80% of the costs for emergency care overseas. Some Medicare Advantage plans cover emergency care overseas as well. A travel insurance policy can provide coverage outside of the United States, but it will depend on the policy.

The takeaway. In five out of seven categories, a Medicare Advantage plan can fill in for Medicare itself. Unfortunately, that means further expenses. Planning for retirement and moving to Medicare for health coverage means considering your own needs and priorities. Consider speaking to a qualified New Jersey elder law lawyer who can provide guidance on Medicare issues, or refer you to an insurance advisor.

Reference: Kiplinger (May 23, 2018) “7 Things Medicare Doesn’t Cover”