Medicare is a health insurance program provided by the federal government for people aged 65 and above. The insurance coverage also caters for people with certain qualified chronic conditions and people living with disabilities. If you are on a limited income, you may still need to budget for healthcare even when on Medicare. It’s essential to know the services covered by Medicare so as not to be surprised by medical bills. The following are things not covered by Medicare:
1. Prescription drugs
Medicare Part A and B do not provide prescription drug coverage. If you need coverage for prescription medication, it would be best to contact a private insurance firm and buy Medicare Part D or a Medicare Advantage plan that includes prescription drug coverage. Medicare drug coverage is non-compulsory. However, if you don’t have it and don’t have alternative creditable drug coverage, you will be penalized for enrolling late if you enroll in the future. The penalty stays when you are under Medicare drug coverage, so it’s good to ensure that you obtain and maintain qualified coverage when you are eligible.
2. Overseas health care
If you go for treatment outside the U.S., Medicare will not cover the cost of treatment or supplies except in exceptional circumstances. For example, if you pass via Canada between Alaska when a medical emergency occurs and the nearest hospital in Canada, you may be covered by Medicare. Alternatively, you will have to obtain additional coverage for travel or buy insurance in your resident country. If you are planning to move abroad, find out the consequences of dropping Medicare before you go.
3. Routine dental exams
Basic Medicare doesn’t cover routine dental cleanings and appointments. You will also have to pay for dentures, fillings, and x-rays. Remember that if your HSA is up-to-date, you can continue contributing to it until your Medicare enrollment. Although you cannot contribute to HAS after registration, the money saved can cater to issues like root canals, tooth extractions, deductibles, copays, and coinsurance.
4. Long term care
Generally, Medicare does not cover long term care. But, while Medicare will not pay for nursing home care, you cannot abandon your coverage after admission. You can still use Medicare for other services, such as medical supplies and hospital care, while in a long term care facility, including physician visits. If you are on Medicare, you can choose to buy a separate long-term care insurance coverage to cater to this level of care.
5. Routine eye exams
Usually, routine eye exams are not covered by Medicare, with exceptions being an annual eye exam for people with diabetes or eyeglasses after some cataract surgery. Suppose you use a Health Savings Account (HSA) before Medicare enrollment. In that case, you can utilize the money tax-free for prescription sunglasses, contact lenses, glasses, or any other vision care out-of-pocket cost.
6. Dentures
Medicare does not cover routine dental checkups or huge issues such as root canals and dentures. Some Medicare Advantage programs provide dental coverage, but if yours does not, or you get out of original Medicare, you can purchase a dental discount or dental insurance plan.
7. Hearing aids
Medicare does not pay for hearing aids or any exams needed to get them. While there is lobbying to include hearing aid coverage in Medicare, Congress is yet to pass the act. Medicare may cover diagnostic hearing tests if your doctor deems them necessary. Alternatively, you can purchase a Medicare Advantage plan that includes hearing benefits if you develop hearing issues.
