Medicare Won’t Cover These 7 Things: How to Save $$$$ Paying for Them

If you’re turning 65 soon, you need to be aware of what things Original Medicare, Parts A and B, doesn’t cover. Some medical coverage we are all used to having in group employer health plans and plans bought through healthcare.gov is not included in Original Medicare.

In this video, I’ll take you through 7 things Medicare doesn’t cover so you’ll be prepared when your Medicare coverage begins. I’ll also let you know what options you have to cover these 7 gaps in Original Medicare. 

​Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To… ​

Medicare Won’t Pay For These 7 Things

1. Prescription Drugs. Medicare Parts A and B do not cover most outpatient prescription drugs. Medicare Part B provides coverage for medications that are given in a doctor’s office but not for medications you take at home. Coverage is available for prescription medications through standalone Medicare Part D plans and Medicare Advantage plans that include Part D coverage. It is in almost everyone’s best interest to enroll in Medicare Part D coverage. The exception to that is people who have creditable prescription drug coverage through an employer group plan or government program like the VA.
2. Long term care. Original Medicare has a limited 100 day benefit for skilled nursing facility care after a qualifying 3 day inpatient hospital stay. This benefit is only available if you need skilled nursing care, which is more than custodial care and assistance with the activities of daily living. Days 1 through 20 are covered at 100% by Medicare. Days 21 through 100 have a per day copay of $194.50.  Medicare Advantage Plans and Medicare Supplements can help pay for part or all of that $194.50 per day copay. Medicare has no coverage for long term custodial care. If a person needs assistance with eating, bathing, and other daily living activities but doesn’t need skilled nursing care, Medicare will not cover a stay in a long term care facility. Medicare Supplements and Medicare Advantage plans also will not pay for long term care. Long term care insurance is available, but purchasing it is a decision that’s best made when you are in your 40s or 50s. There are also combination life insurance and long term care policies available. Another option, if you are enrolled in a qualified health plan, is to save money in a health savings account to pay for future long term care. Again, the best time to make decisions about funding long term care is when you are many years away from Medicare enrollment.
3. Dental Care. Medicare provides very limited dental care related to underlying medical conditions, but Medicare has no coverage for routine dental care or major services like crowns, oral surgery, or dental implants. There are standalone dental plans that you can purchase that provide annual benefits of up to $5,000 if you expect to need comprehensive dental work.
4. Vision Care. Medicare doesn’t cover routine eye exams or glasses or contacts. Medicare does have some limited benefits for vision care if you have diabetes or need cataract surgery. There are standalone vision insurance plans that you can purchase to provide coverage for routine exams and prescription glasses and contacts. There are also many vision discount programs available at low or no cost that could help you save on vision care.
5. Hearing Care. Medicare does not cover routine hearing exams or hearing aids. There are plans that combine dental, vision, and hearing care which you can purchase separately to help cover hearing care costs.
6. Foreign Travel. Medicare will not cover any medical care outside the United States. Not even emergency care. If you travel internationally with only Medicare Parts A and B, you are on your own for any medical costs. Most Medicare Supplements include a benefit for emergency medical care while traveling internationally. However, there’s a $50,000 lifetime cap on that benefit, and you may have to pay providers first and get reimbursed by your Medigap plan later. Medicare Advantage plans usually include worldwide emergency coverage, but medical providers in foreign countries may not accept your plan. If you will be travelling internationally, I strongly recommend you purchase a travel health insurance policy. These are not that expensive and could save you tens or hundreds of thousands of dollars in the case of a medical emergency overseas.
7. This is the most important difference between health insurance we have before age 65 and Medicare. Medicare Parts A and B have deductibles and copays and coinsurance. We’re all used to those from our group or individual health insurance we’ve had for decades. Medicare has one giant difference. With our group employer plans and individual ACA plans, there’s always a maximum out-of-pocket spending limit. There’s always a contract provision that if you spend $10,000 or 15 or $20,000 or whatever the contracted limit is, out of your own pocket for your medical care during the year, that once you hit that dollar amount, the insurance company will take over and pay all your covered medical expenses for the rest of the year at 100% with you owing nothing for the rest of the year. A health plan’s out-of-pocket maximum is the limit of your financial risk for the year with that plan. Medicare Parts A and B do not have out-of-pocket spending limits. That means you will pay the Medicare Part A deductible, copays, and coinsurance every single benefit period forever with no limit on what you can spend. You will pay the Medicare Part B annual deductible, which is only $233, and 20% of all other covered outpatient Medicare Part B services with no limit. This 20% on outpatient services is a big risk. Many procedures, surgeries, chemo treatments, and prescription infusions done in a doctor’s office are extremely expensive. Your 20% responsibility under Medicare Part B will run into the thousands and tens of thousands of dollars. Because Medicare Part B has no cap on how much you can spend. Medicare Parts A and B will never take over your health costs at 100% no matter how much you spend out of your pocket. The good news is that whether you choose a Medicare Supplement or a Medicare Advantage plan, both those types of coverage give you a cap on your spending. Even if you are in good health when you turn 65, it’s in your best interest to enroll in a Medicare plan that will cap your out-of-pocket health spending to protect your retirement assets.

If you have questions about Medicare coverage, please feel free to give our office a call at 877-312-1414 or reserve a free, no obligation Medicare Plan Consultation. 

We’re here to explain your Medicare options and help you find the right coverage for you!