Medicare was signed into law over half a century ago.
At that time, Medicare included two parts: Part A, which is hospital insurance and Part B, which is non-hospital medical insurance. Like just about everything else, Medicare has changed in the 50-plus years it has been around. For one thing, more people are eligible. In 1972, it was expanded to cover disabled people and people with end-stage renal disease that requires dialysis or a kidney transplant.
Prescription drug coverage has been offered since 2003, at which time Medicare Advantage Plans emerged. Medicare Advantage Plans are sometimes called “Medicare Part C,” and they are private health plans approved by Medicare that those eligible can choose as an alternative to traditional Part A and Part B coverage.
There’s no question that Medicare is an excellent social program that puts a financial safety net under older people who may be less able to pay for healthcare as they retire and their health deteriorates. But it certainly doesn’t cover everything, and anyone close to age 65 (or anyone who loves someone who is) should know what’s excluded from Medicare coverage. Here are 7 services Medicare doesn’t pay for.
1. Dental Care
Perhaps the biggest gap in Medicare coverage is for dental care. In other words, if you have Medicare but do not have private dental coverage on top of that, you’ll have to pay for all your dental care yourself, including preventative services, cavity filling, or dentures. If there’s an extreme dental emergency that’s bad enough to send you to the hospital, Medicare Part A will cover some of the costs, but otherwise, seniors must pay for their own dental services or obtain private dental coverage. This can be a major issue, too, because many of the medical conditions seniors have, and many of the medications they take can cause side effects like dry mouth, which can lead to cavities.
2. Eye Exams for Glasses
If you need an eye exam, glasses, or contact lenses, you’ll be paying for them out of your own pocket, unless you have, for example, private vision coverage through a spouse. This can be a problem, because many vision problems either don’t begin until middle age or older, or get worse with age.
Fortunately, however, there are some exceptions. Say you have to have cataract surgery, including the implant of an intraocular lens. If that’s the case, Medicare Part B will pay for corrective lenses. Diabetics can also have an annual eye exam that’s covered by Medicare Part B to check for diabetic damage to the eyes. People with conditions like macular degeneration are covered for some exams and treatments, but for ordinary vision care, seniors are on their own.
3. Hearing Aids or Hearing Aid Fitting Exams
When we think of hearing aids, we tend to think of older people. After all, around half of seniors over age 75 experience some degree of hearing impairment. Medicare won’t help if you have diagnostic tests or are fitted for hearing aids. There are some diagnostic tests that, if recommended by your primary care physician, are covered by Medicare Part B, but for ordinary hearing care, you will foot the bill yourself.
This can cause difficulty for a couple of reasons. For one, hearing aids are expensive, running anywhere from $1,600 to $3,500 for a single unit, and most people need two. What’s more, hearing loss can lead to social isolation and increase rates of depression among seniors, so if you anticipate needing hearing care, start saving up for it.
4. Routine Foot Care
If you have a foot injury, or a foot disease like diabetes-related nerve damage, bunions, or hammertoes, Medicare will pay for diagnosis and treatment. However, when it comes to routine foot care, like the removing of calluses, patients must pay out of pocket. Neither will Medicare pay for most orthopedic shoes or custom orthotics.
As people get older, proper fit of shoes is more important than ever, because ill-fitting shoes can cause forefoot pain, toenail trauma, or bunions. And the primary market for orthopedic shoes is older individuals. Like dental, vision, and hearing care, however, the typical senior will need to pay for routine foot care from their own money, because Medicare Part B generally doesn’t cover it.
5. Medical Care Outside the United States
Medicare doesn’t pay for healthcare delivered outside the United States, except under very specific conditions. If, for example, you are located in the US, but the closest hospital to you is a Canadian hospital, Medicare will cover those hospital services under Medicare Part A. Seniors who are traveling through Canada on their way to or from Alaska and who experience a medical emergency will also be covered for services received in a Canadian hospital. If a senior is on a ship within territorial waters adjoining the US and requires medical services, those services are also covered.
Many seniors enjoy travel during retirement, and if they go overseas, it’s critically important that they obtain travel medical insurance beforehand to prevent financial catastrophe.
6. Alternative Medicine
With the exception of chiropractic treatment for subluxation of the spine, no types of alternative or complementary medical care are covered by Medicare. So if a Medicare recipient, for example, wants to explore acupuncture or another non-Western medical treatment, he or she must be prepared to pay for it out of pocket.
7. Long Term Care
Many people are surprised to learn that Medicare doesn’t pay for long-term care. Medicare Part A will cover care in a skilled nursing facility after a three-day inpatient hospital stay. Moreover, Medicare recipients are limited to 100 days of covered care. Low-income seniors may be eligible for Medicaid coverage for some long-term care, including nursing home care, but people with financial assets are far better off obtaining long-term care insurance. Otherwise their assets will have to be used to pay for care until such a time as they’re impoverished enough to qualify for Medicaid coverage of long-term care.
Ways to Fill Coverage Gaps
There are ways to fill coverage gaps, however. Many seniors, instead of opting for Medicare Part A and Part B, choose instead to have a Medicare Advantage Plan, many of which cover more services than traditional Medicare. It costs extra for enrolling in a Medicare Advantage plan, but typically the premiums are modest enough to be affordable.
Many seniors find that signing up for a Medicare Advantage plan offers peace of mind, since many of these plans have yearly out-of-pocket maximums. This can be a significant relief if hospitalization is necessary, because hospital bills add up so quickly. It’s important for seniors to know that Medicare Advantage plans differ, and one should be chosen based on coverage needs. For example, a senior with dental problems should evaluate Medicare Advantage plans that offer dental coverage.
Medicare is one of the most significant social safety nets in the United States, but it is not perfect. Many costs that people are used to having covered under employer-sponsored health insurance are not covered under traditional Medicare. The good news is, seniors can choose an alternative to traditional Medicare through a Medicare Advantage plan and may be able to enjoy coverage more closely attuned to their needs.
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