Original Medicare covers many things, but not everything. These are the services that Medicare usually
doesn’t offer coverage for.
One of the things that makes Medicare such a useful healthcare solution for seniors and eligible
citizens is the comprehensive coverage that it offers. While this is an obvious plus, there are some
things that Medicare doesn’t usually cover. There are also some things that it only partially covers. We
talk a lot about what Medicare covers on Medicareful Living, but discussing what generally isn’t
covered is equally important, if not more important.
For this article, we’ll be focusing on Original Medicare. Since Medicare Advantage (Part C) plans can
have differing coverage from plan to plan, they may cover some of these entries in some way. If that’s
the case, we’ll make a note that it may be an option for you. Otherwise, if you think you’ll need one of
these services, you’ll want to look at the specifics of a certain plan to make sure it’s the right one for
you. If you have particular healthcare needs that relate to the items we’ll discuss below, it may also be
worth working with a licensed sales agent to find the plan for you or checking out our Medicareful Plan
Finder.
Hearing loss is a condition about one in three seniors ages 65 to 74 around the country face. In fact, by
the time they’re 75, nearly half of all seniors experience some form of hearing loss. This can make
being able to get a hearing aid vital to maintaining a good quality of life. Unfortunately, Medicare rarely
covers hearing aids, hearing exams, and hearing aid fittings. Specifically, Original Medicare only
covers hearing aids if they’re bone-anchored hearing aids (BAHA), since those types of hearing aids
are now considered prosthetics and also rarely if ever, cover hearing aids.
Can I Get It Covered?
If you find yourself needing hearing aids, there are a few places you can turn. First, you can try a
Medicare Advantage plan. Many offer some form of hearing coverage, though you may still have some
out-of-pocket costs with a purchase. Medicaid may also offer hearing aid coverage, depending on the
state and if you qualify for coverage. Some private charities and associations, like the Starkey Group,
can offer financial aid. The Hearing Loss Association of America also offers information about how to
get financial aid for those in need. Finally, you can find a standalone dental, vision, and hearing
insurance plan to cover all three needs and supplement your Medicare coverage.
Routine Dental Work and Dentures
Speaking of dental coverage, routine dental work is not covered by Original Medicare. This means
you’ll likely be paying out of pocket for dentist visits, cleanings, and even dentures if you have
Medicare. The only way that Original Medicare may cover dental work is if it’s part of something that
Original Medicare normally covers, like surgery as part of inpatient care. In a circumstance where there is some coverage of dental care, a Medicare Supplement may help by possibly covering deductibles and coinsurances.
Can I Get It Covered?
Many Medicare Advantage (Part C) plans offer some form of dental coverage, though this differs from
plan to plan and is limited to certain services. Part C plans often will cover routine coverage like
checkups, preventative cleanings, and oral exams, to name only a few. However, this coverage
typically doesn’t extend, or fully extend, to some major dental procedures like crowns or dental items
like dentures. This can make reading the fine print of your Medicare Advantage plan very important. If
you want coverage for dentures or routine dental procedures, it may also be worth finding a standalone dental plan or a combination dental, vision, hearing plan.
Routine Vision Care
So, we’ve discussed dental and hearing, and how they’re generally not covered by Medicare. But, is
eye care covered? Unfortunately, that’s also a no, if you’re referring to routine care. Luckily, Original
Medicare does cover certain preventative and diagnostic exams for conditions like glaucoma, diabetes,
and macular degeneration. It can also cover things like medically-necessary cataract surgery.
However, services and checkups, like regular eye exams or glasses or contact lens fittings, generally
aren’t covered by Original Medicare. The same goes for Medigap plans, which do not cover routine
vision services. This means that 100 percent of the costs of these regular checkups and fittings will be
out-of-pocket expenses for you.
Can I Get It Covered?
Similar to dental and hearing, you can get many of your vision coverage needs in the right
Medicare Advantage plan. A large number of Part C plans cover vision benefits in some way, though the amount covered and the costs associated with this coverage varies between plans. While it doesn’t
cover the checkups, you can also get some vision coverage through Medicare Part D. This coverage is
largely related to vision medications and prescription eye drops and differs depending on the plan you
have. You can also get a stand-alone vision insurance plan or a combined dental, vision, and hearing
plan to help cover your vision needs.
Custodial Long-Term Care Services
There may come a point in your life when you require help with daily tasks beyond what your family
and friends can provide. You may eventually need long-term care services. If you need help with
everyday tasks like eating, washing, and dressing, this would be considered custodial long-term care.
Since this type of help is not considered medically necessary, Original Medicare won’t assist with
paying for this type of long-term care. It may assist with the costs of a skilled nursing facility,
like a semi-private room or prescription drugs, if they become medically necessary but the custodial
care is still your responsibility.
Can I Get It Covered?
Luckily, unlike other options in this article, there are ways to get help from Original Medicare for long-term care. If you qualify for PACE or hospice care, certain long-term care needs may be covered.
Original Medicare may also assist with long-term care hospitals or some home health services.
Medicaid can help cover some costs of long-term care as well. Alternatively, you can enroll in a long-term care insurance plan to have all your bases covered.
Cosmetic Surgery
Cosmetic surgery usually isn’t covered by Original Medicare. In fact, there are very few circumstances where cosmetic surgery is covered. Most cosmetic surgery is considered to be elective or nonessential surgery since it’s not medically necessary and is often done to fix a certain perceived physical
imperfection. This differs from plastic surgery, which is often focused on reconstruction or defects due
to birth disorders, trauma, or disease.
Can I Get It Covered?
The difference between cosmetic surgery and plastic surgery can make a large difference in your
coverage. Original Medicare will cover cosmetic or plastic surgery if it’s caused by an accidental injury
or to improve the function of a malformed body part. It may also cover breast prostheses if you’ve had a
mastectomy due to breast cancer. Some companies also offer cosmetic surgery insurance, though this
is rare and should be thoroughly researched before purchasing. The non-essential nature of most
cosmetic surgery procedures makes coverage for it rare, meaning you’ll likely be footing the entire bill.
Care Outside of the U.S.
Let’s say you’re on vacation and you get sick. You need health care. Does Medicare cover you? If you
happen to be inside the United States, generally speaking, you should be able to get coverage,
depending on the service. Original Medicare is accepted throughout the country. With Medicare
Advantage, the answer is a little murkier since they have plan networks. If you’re venturing outside of
the country, though, you won’t likely receive the same Medicare coverage you’re used to, if any.
Can I Get It Covered?
There are a few instances where Medicare can cover some of your expenses outside of the United
States, though they are very specific. These are:
- If you have a health emergency in the U.S., but the nearest hospital that can assist you is in another country.
- If you’re in Canada while traveling the most direct route between Alaska and the continental U.S. when the emergency occurs. In this case, a Canadian hospital must be the closest hospital and your trip must not be taking any “unreasonable delay[s].”
- If you live in the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition. In this instance, a medical emergency is not required for coverage.
Otherwise, you’ll likely be covering your own bills. You may be able to get a travel insurance plan,
though not all of them cover health care, so read the coverage closely before enrolling in a plan.
Finally, some Medicare Supplements and Medicare Advantage plans offer coverage for foreign travel,
which can be wise if you’re planning on traveling abroad.
Medicare, and specifically Original Medicare, covers many of the crucial healthcare needs of seniors
and eligible Americans around the country. But, it can’t cover everything. Luckily, if you do need one of
the health care services or items that aren’t traditionally covered by Original Medicare, there’s often a
way to get some financial assistance. This way, you can afford the care you need without your quality
of life is impacted. While this could mean that Medicare isn’t the only insurance you may need
depending on your circumstances, it’s good to know that there are options out there.
There is no better time to re-evaluate your current situation than the present. Connect with a licensed financial professional at Alfa Pride Financial, to assess where you are on your financial journey, and get the financial keys to a worry-free life.
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