Medigap doesn't cover

What Medicare Does Not Cover

by MarkG

Medicare Doesn’t Pay For Everything

An informed healthcare consumer is a powerful healthcare consumer. Whether you are newly eligible for Medicare or you’re looking to educate yourself about all available services, it’s important that you understand what Medicare does and does not cover. It may help you with most of your basic needs, but there are gaps in the Medicare that you need to be aware of.

If you find Medicare to be confusing, you’re not alone. A 2013 survey by United Healthcare found that 20% of adults age 65 and over think that Medicare is confusing.

We’re here to help clear things up for you. The following services are ones that you will need an additional policy for — or you’ll end up paying for them out of your own pocket.

Dental Care

One of the benefits you have likely had your whole life is a Dental plan. If you had employer benefits like the majority of Americans do, you got used to get your teeth cleaned semi-annually and having work done on your teeth as needed.

Medicare does not cover Dental care. You will either have to get a separate plan that covers Dental alone or look into a private plan that covers Dental/Vision/Hearing. You can get Dental wrapped into a Medicare Advantage, but the benefits are so minimal, usually twice a year cleanings and nothing more, that getting a separate plan is highly recommended.

Hearing Assistance

Has the volume on the TV been up a little higher lately and you’re still struggling to hear it? You might need to schedule a hearing test. Unfortunately, neither Medicare Part A nor Part B will cover this. Medicare also will not pay for your hearing aids if you need them.

Medicare doesn’t cover hearing assistance because of the elective vs. necessary process. Hearing tests and hearing aids are considered elective, not necessary, services. This means that you’ll likely end up paying for these things yourself. There are many individual policies designed to cover hearing services. Many Medicare Advantage plans come with a hearing benefit included.

Eye Care

In most cases, Medicare will not cover routine eye exams or your eyeglasses; you’ll need to either pay for these out of your own pocket or purchase an additional plan to help keep your eyes in good shape. Once again, many Medicare Advantage plans have a small vision benefit built in.

However, there are a few exceptions to this rule. Part A will cover vision problems when they are considered to be a medical problem. For example, it will kick in if you have a traumatic eye injury and are admitted to the hospital. Part B will cover one pair of eyeglasses if you need them after you have a cataract removed, and it may also cover the cataract surgery.

Annual glaucoma screenings for high-risk individuals also fall under Part B coverage. High risk people include those with diabetes, African Americans over age 50, and Hispanic Americans over age 65.

Routine Foot Care

Whether or not Medicare will cover podiatrist services also depends on whether or not the service is deemed medically necessary. You won’t be covered for procedures like callous or corn removal. It also won’t cover clipping of your toenails or hygienic treatments.

Fortunately, Parts A and B will cover some foot treatments. Treatment for hammertoes, bunions, and heel spurs may be covered because these procedures are often considered medically necessary.

Homeopathic Treatments

Homeopathy uses natural substances to fight disease. It isn’t considered to be a medically necessary service, so this expense will come out of your own pocket. Other treatments that may be labeled as alternative medicine are also not covered. For example, Medicare doesn’t cover acupressure or acupuncture.

The one exception to this rule is chiropractic treatments. Although chiropractic is technically considered an alternative medicine, Part B does cover it to some degree. If the service is deemed medically needed versus someone just needing a back adjustment it is usually covered.

Custodial Care

Parts A and B do not cover custodial care, also known as long-term care. This type of care includes in-home services such as assistance with bathing, cleaning, eating, dressing, or using the bathroom. However, Part A will help you with the cost of skilled nursing facility care. These services often can be covered in a short term, e.g. someone who was just released from the hospital.

Medicare covers home health care, which includes things such as medical equipment, physical therapy, and speech-language pathology. However, Medicare’s criteria for covering these things are very strict. One of the following statements must be true about you if you wish to qualify for this type of assistance:

  • You can’t leave home without help from another individual, special transportation, or a supportive device (like a wheelchair or cane).
  • You have a condition that makes it inadvisable for you to leave your home.

There are other requirements that you must meet to take advantage of Medicare-covered home health care, and a Medicare expert can guide you through the process and answer all of your questions.

Your doctors might suggest that you get treatments or services that Medicare doesn’t cover; don’t automatically say yes to these before you ask questions about the cost. You don’t want to end up with the stress of extra medical bills. However, you do want to maintain your health. You should research medical supplement plans and choose one that fits your needs. I mentioned Medicare Advantage covers some things. It is important to remember that the benefits are minimal and restricted to small networks. You are always better off looking into your own policy to compliment a Medicare Supplement.

Share this blog post with your friends so they, too, can get a better grasp on what their Medicare does and does not cover. If you have questions, call us at 800-708-5810 or email us at [email protected]

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