Traditional Medicare covers a lot of medical expenses after you turn 65. Hospital insurance (or Part A) helps people pay for inpatient hospital stays, skilled nursing facilities, hospice, surgery, and home care. Medical insurance (or Part B) covers doctor’s visits, outpatient care, preventive services, and medical equipment and supplies. Despite these provisions, there are some significant gaps in Medicare coverage. Here’s a brief look at what is not covered by traditional Medicare:
Dental care
Routine dental services such as fillings, cleanings, and X-rays are not covered by Medicare. It only covers some dental services that people may get as a part of their hospital stay. The Medicare Advantage plan covers some extra services, but those looking for holistic dental insurance may need a separate coverage policy.
Eye exams
Eye exams for glasses or contact lenses are not covered under Medicare. The glasses and lenses themselves are not covered either. Medicare Part B partially covers one pair of glasses or contacts for people undergoing cataract surgery.
Hearing aids
The cost of hearing aids and the exam required for getting hearing aids are also not covered by Medicare. However, diagnostic hearing exams may be covered if prescribed by a doctor. Opting for the Medicare Advantage plan may be better for people seeking additional hearing benefits.
Long-term care
Although people over 65 have a high chance of needing long-term medical care since Medicare does not entirely cover it. 100 days of care at a skilled nursing facility may be covered after a qualifying three-day in-patient stay, along with a daily coinsurance charge if the doctor recommends it. After 100-days, patients must cover their costs.
Deductibles and coinsurance
Original Medicare requires some amount of out-of-pocket spending in the form of deductibles and coinsurance. There is no cap on Original Medicare spending. Those opting for Medicare Advantage will have to pay out of pocket, but there is a $7,500 cap on this spending in 2022 (and $8,300 in 2023).
Conclusion
Other services like massage therapy, routine physical exams, concierge care, alternative treatments, and most chiropractic care are also not covered under original Medicare. However, people may purchase long-term care insurance or a combination of long-term care and life insurance policies to cover some of these costs and reduce their out-of-pocket expenditures.
Note that Medicare Advantage Plans (or Plan C) are offered by private companies such as UnitedHealthcare. Depending on their needs, insurers can choose from various Medicare Advantage plans such as Home Maintenance Organization, Preferred Provider Organization, Private Fee-For-Service Plans, Special Need Plans and others. These plans can be instrumental in reducing out-of-pocket costs for covered services annually.