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What Medicare Doesn’t Cover

"It's important to understand that Medicare Part A and Part B leave some pretty significant gaps in your health-care coverage."

Medicare Part A and Part B, also known as Original Medicare or Traditional Medicare, cover a big part of your medical expenses after you turn age 65. It is important to understand what Medicare doesn’t cover. Kiplinger’s recent article entitled “7 Things Medicare Doesn’t Cover” reviews what isn’t covered by Medicare, plus information about supplemental insurance policies and strategies that can help cover the additional costs, so you don’t end up with unexpected medical bills in retirement.

Prescription Drugs. Medicare doesn’t provide coverage for outpatient prescription drugs. However, you can buy a separate Part D prescription-drug policy that does, or a Medicare Advantage plan that covers both medical and drug costs.

Long-Term Care. One of the biggest possible expenses in retirement is the cost of long-term care. However, you can purchase long-term-care insurance or a combination long-term-care and life insurance policy to cover these costs.

Deductibles and Co-Pays. Medicare Part A covers hospital stays, and Part B covers doctors’ services and outpatient care. However, you’re on the hook for deductibles and co-payments. In 2020, you’ll have to pay a Part A deductible of $1,408 before coverage begins, and you’ll also have to pay some of the cost of long hospital stays – $352 per day for days 61-90 in the hospital and $704 per day after that. Over your lifetime, Medicare will only help pay for a total of 60 days beyond the 90-day limit, called “lifetime reserve days,” and thereafter you’ll pay the full hospital cost.

Dental Care. Medicare doesn’t provide coverage for routine dental visits, teeth cleanings, fillings, dentures or most tooth extractions. There are some Medicare Advantage plans that cover basic cleanings and X-rays, but they generally have an annual coverage cap of about $1,500. Look at coverage from a separate dental insurance policy or a dental discount plan.

Routine Vision Care. Medicare doesn’t cover routine eye exams or glasses (exceptions include an annual eye exam, if you have diabetes or eyeglasses after having certain kinds of cataract surgery). However, there are Medicare Advantage plans that have vision coverage, or you may be able to buy a separate supplemental policy that provides vision care alone or includes both dental and vision care.

Hearing Aids. Medicare doesn’t provide coverage for routine hearing exams or hearing aids, which can cost as much as $3,250 per ear. However, a few Medicare Advantage plans cover hearing aids and fitting exams, and some discount programs provide lower-cost hearing aids.

Medical Care Overseas. Medicare doesn’t cover care you get while outside of the U.S., except for very limited circumstances (such as on a cruise ship within six hours of a U.S. port). Medigap plans C through G, M and N, however, cover 80% of the cost of emergency care abroad, with a lifetime limit of $50,000. Some Medicare Advantage plans cover emergency care abroad.

If you would like to learn more about Medicare, please visit our previous posts.

Reference: Kiplinger (Oct. 1, 2020) “7 Things Medicare Doesn’t Cover”