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5 Most Significant Things Medicare Doesn’t Cover

5 Most Significant Things Medicare Doesn’t Cover

Medicare Parts A and B are great at covering necessary medical procedures and doctor visits, but Parts A and B don’t cover everything you’ll need. Many enrollees are surprised to find some services and items that are not covered under their Part A or B Medicare plans. Unless you have a plan that goes beyond what “original” Medicare covers, you’ll be paying for these services yourself.  There are plans such as Medigap Plan F who cover the 20% after Medicare pays their usual 80%. There are also plans called Medigap Plan G that usually cost less monthly but have an annual deductible. If you would like us to compare Medicare supplemental plans, we are happy to assist you in finding the best plan for you.

Prescription Drugs

For many people entering into Medicare, this is one of the most surprising things that Medicare doesn’t cover. While original Medicare does cover drugs and medications that are given inside of the hospital by a trained professional, neither Part A nor Part B includes any medications that are self-administered. Anything other than those drugs given during a hospital stay won’t be covered under Medicare.

Typically prescription medications are one of the largest portions of a Medicare enrollee’s budget. The best way to cover the cost of expensive drugs is to enroll in a Medicare Part D plan. These drug plans are offered by private insurance companies and can drastically reduce the amount spent on prescription medications every year.

Long-term Care

Medicare Parts A and B have specific restrictions and limitations on the quantity of time the plans will cover. While it’s often needed, Medicare does not cover stays in nursing homes or assisted living homes. Medicare will pay for a stay in a skilled nursing facility or rehabilitation care facility for 100 days if it’s following an inpatient hospital stay. If it’s not following an inpatient hospital visit, then you’ll be paying for the facilities on your own.

There are separate long-term care insurance policies that one can purchase to cover more long-term, permanent care scenarios.

Hospital Care Outside of the United States

Hospital care outside of the United States is one of the less frequent services asked about, but can sometimes cost enrollees the most. Many retirees use their free time to travel to other countries for extended periods. In most cases Medicare will not cover any health care services or supplies that you receive while, outside the U.S, this excludes Puerto Rice, the U.S. Virgin Islands, the District of Columbia, Guam, and a few other specific islands where you can receive coverage.

If you’re traveling outside of the U.S., the official Medicare site does list three specific situations that you can receive Medicare coverage. The first is that you are in the United States when you have a medical emergency, but you’re closer to a foreign hospital that can treat your illness. The second situation is if you’re traveling through Canada to reach Alaska, and you require sudden medical attention. The last situation is that you live in the U.S., but you live closer to a foreign hospital. If you fall under one of these situations, you can receive medical attention with Medicare covering the services.

Personal Care

Personal care expenses often aren’t considered when enrolling in Medicare, but the costs can add up quickly. Medicare covers skill nursing services and skilled therapy services depending on the situation.  Services like housekeeping, shopping, cleaning, or cooking are not covered under Part A or Part B unless the services are a part of hospice care.

Vision, Dental, Hearing Care

These three are one of the most frequent services asked about when discussing Medicare. Although Medicare enrollees often need glasses, contacts, hearing aids, or dentures, none of these items are covered under the original Medicare, unless under particular circumstances. If you have to get contacts or glasses as the result of a cataract surgery, they will be paid for Medicare. Medicare also does not cover routine dental or vision visits and checkups. Similarly, hearing aids aren’t covered unless hearing loss is a result of other severe health complications.

There are separate plans you can purchase, called Medigap plans, that will complement Medicare and cover some dental, vision and hearing care, including preventive checkups and a percentage of more comprehensive services.

The in’s and out’s of Medicare can become confusing, especially for someone that is receiving several different goods and services. The best way to figure out if your services are covered under your Medicare plan is to check on the Medicare website at medicare.gov/coverage or to call Medicare at 800-633-4227.

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