Can You Afford The Expenses That Medicare Doesn’t Cover?

You probably understand what health insurance covers and doesn’t by the time you turn 65. However, Medicare is a different animal, and there are a few surprising things it doesn’t cover.

Medicare is the name of the federal government’s health insurance program for seniors (age 65 and over), individuals with disabilities, and those with specific chronic illnesses. Medicare does not cover seven things listed below:

1. Coinsurance and deductibles

If you choose Original Medicare, you will have to pay deductibles and coinsurance for Medicare Part A, hospital insurance, and Medicare Part B, medical insurance. Since Original Medicare doesn’t have an out-of-pocket expenditure limit, it might become expensive if you have medical demands.

According to Gretchen Jacobson, vice president of Medicare for The Commonwealth Fund, a private foundation to promote a high-performing healthcare system, “many people on traditional Medicare acquire a Medigap plan to cover these costs and bring predictability to their out-of-pocket costs.”

You will also be liable for any deductibles, copays, or coinsurance needed when you seek medical attention if you choose to enroll in a Medicare Advantage plan provided by private insurance firms that have a contract with the federal government. Although Medicare Advantage has an out-of-pocket cap, that amount may reach $7,550 in 2022.

2. Regular dental visits

Basic dental treatment like cleanings, X-rays, and fillings is not covered by Medicare Part A, even though some dental services you would receive as part of a hospital stay are covered. You must get a separate dental policy if you want coverage.

You might acquire some coverage by obtaining a Medicare Advantage plan with dental benefits. But according to Lina Walker, vice president of health security for AARP’s Public Policy Institute, “those benefits might be restricted, or Medicare Advantage plans can require you to pay extra for those services.”

3. Prescription medications

Prescription medication coverage is not available under Original Medicare Parts A and B. You may either purchase a Medicare Part D plan from a commercial insurance provider or enroll in a Medicare Advantage plan offering prescription medication coverage if you desire it.

Although Medicare drug coverage is voluntary, if you elect not to join and don’t have any other acceptable drug coverage, you will be charged the late enrollment fee when you decide to do so. Once you become eligible, it is essential to seek and maintain qualifying coverage since you will be subject to this fine as long as you have Medicare prescription coverage.

4. Hearing aids

Additionally, neither hearing aids nor the tests necessary for them are covered by Medicare. The Build Back Better Act has some wording allowing Medicare to pay for hearing aids, but Congress has not yet approved the legislation. However, Medicare will pay the cost if your doctor determines that you require a diagnostic hearing test.

5. Eye tests

Medicare does not pay for eye tests for glasses, contacts, or actual lenses. Medicare Part B does pay for one pair of glasses or contacts if you have cataract surgery. You’ll be responsible for 20% of the costs after the $233 Part B deductible in 2022.

6. Long-term care

A Department of Health and Human Services estimate shows that a person turning 65 today has a roughly 7-in-10 probability of eventually needing long-term care, which may be pretty expensive. However, if long-term care is the sole treatment you require, Medicare does not pay for it.

People may be confused about this because they have heard that Medicare covers nursing services, according to Walker. Medicare does fund skilled nursing facility care if your doctor suggests it following a required three-day inpatient hospital stay.

In such cases, Medicare pays for the first 100 days of care in addition to a daily coinsurance fee. After that, all expenses are your responsibility.

Plans for Medicare Advantage could provide a few extra, restricted benefits. Although very few Medicare Advantage plans currently offer it, some do, according to Jacobson. However, the coverage is presently somewhat restricted.

7. International healthcare

Medicare does not cover medical services or supplies if you reside outside the United States and certain U.S. territories, except in a few extremely limited situations. You’ll need to get additional travel insurance or buy insurance in the country where you reside.

Contact Information:
Email: [email protected]
Phone: 6122163911

Mickey Elfenbein specializes in working with Federal Employees relative to their retirement benefit plans, FEGLI, TSP, Social Security and Medicare, issues and solutions. Mr. Elfenbein’s mission is to help federal employees to understand their benefits, and to maximize their financial retirements while minimizing risk. Many of the federal benefit programs in place are complicated to understand and go through numerous revisions. It is Mr. Elfenbein’s job to be an expert on the various programs and to stay on top of changes.Mickey enjoys in providing an individualized and complimentary retirement analysis for federal employees.He has over 30 years of senior level experience in a variety of public and private enterprises, understands the needs of federal employees, and has expertise built on many years of high-level experience.

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