What Doesn’t Medicare Cover?

Uncovering the Gaps: What Doesn’t Medicare Cover?

As we age or face Medicare cover disabilities, healthcare becomes an increasingly critical aspect of our lives. Medicare provides invaluable support to seniors and individuals under 65 with certain disabilities. However, while it covers a wide range of health services and supplies, it’s not an all-encompassing program. Understanding what does not cover can help you plan better for your healthcare needs and avoid unexpected expenses.

Common Services and Supplies Not Covered by Medicare

Long-Term Care

One of the most significant exclusions in Medicare coverage is long-term care, also called custodial care. Medicare will not cover these services if you need assistance with daily activities like dressing, bathing, or using the restroom over an extended period. These are typically required by those with chronic illnesses, dementia, or disabilities who require ongoing personal care. Medicare will provide skilled nursing services following an Admitted Hospital stay.

Most Dental Care

General dental services, including cleanings, fillings, tooth extractions, dentures, and most dental plates, are not covered by Medicare. Without additional insurance or alternative programs, dental procedures can become out-of-pocket expenses.

Eye Examinations for Prescription Glasses

Routine eye exams for prescription glasses are another area where Medicare coverage does not apply. Similarly, costs for contact lenses and eyeglasses are generally not included, with some exceptions for post-cataract surgery if glasses are required.

Cosmetic Surgery

Suppose you’re considering any cosmetic surgery to improve your appearance. In that case, it’s important to know that these procedures are not covered unless they are medically necessary, such as when an injury has occurred or to improve the function of a malformed body part.

Hearing Aids and Related Fittings

Hearing impairment can be a significant challenge, but Medicare coverage does not extend to hearing aids or the exams for fitting them. This exclusion affects many seniors who require these devices for improved quality of life.

Routine Foot Care Medicare cover

While certain foot-related conditions may receive coverage, routine foot care, including the cutting of corns and calluses or toenail trimming, is generally not covered. This exclusion can be particularly relevant for individuals with diabetes or vascular disease, who often require regular foot care.

Additional Items and Services Excluded from Medicare

Alternative medicine, such as acupuncture, except for a few specific conditions.
Most chiropractic services, except for manual manipulation of the spine to correct a subluxation.
Health care while travelling outside the United States, barring a few exceptions.
Private-duty nursing.
Personal comfort items, such as a hospital phone or television.
Elective surgeries which are not deemed medically necessary.

Closing the Gaps in Coverage

To fill these coverage gaps, many turn to Medicare Advantage Plans (Part C), Medicare Supplement(Medigap) Plans or other insurance providers that offer supplementary options, such as dental and vision benefits. There are also separate Medicare Part D plans for prescription drugs that are not covered by the original Medicare.

It’s crucial to explore these options and understand the costs involved and the terms of coverage. Additionally, some state Medicaid programs might offer assistance for services not covered by Medicare, particularly for those with limited income and resources.

Conclusion

Navigating healthcare needs can be complex, but understanding Medicare’s limitations empowers you to seek out the necessary additional coverage. Invest time in reviewing the specifics of your Medicare plan and consider supplementary insurance to ensure that your health needs will be fully met. Planning ahead for these uncovered services can help maintain your health and financial well-being in the long term.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.

Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.

Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:

Original Medicare (Parts A & B): Allows you to see any doctor or
hospital that accepts Medicare but does not include prescription drug
coverage (Part D) or additional benefits.
Medicare Advantage (Part C): Offers bundled coverage with
potential extra benefits but may require using a network of providers.
Medigap (Medicare Supplement Insurance): Helps cover
out-of-pocket costs not covered by Original Medicare, such as
copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:

Initial Enrollment Period (IEP): A seven-month window starting
three months before your 65th birthday month.
General Enrollment Period (GEP): From January 1 to March 31
each year for those who missed their IEP.
Annual Election Period (AEP): From October 15 to December 7,
allowing you to switch or enroll in Medicare Advantage and Part D
plans.
Open Enrollment Period(OEP): From January 1 to March 31 for
those who missed AEP and want to make certain changes.
Special Enrollment Period(SEP): Can be used anytime during the
calendar year for those that meet certain criteria such as moving to a
new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.

By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.

Do I have to sign up for Medicare?

It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.

Does Medicare cover Prescription Medications?

No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.

I want to be able to go to any doctor/hospital, are there networks with Medicare?

There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.