Healthcare • April 8th, 2020

8 things Medicare doesn't cover

Gail Kellner

Key Takeaways
  • Medicare Parts A and B cover most of your medical expenses.
  • Medicare doesn't cover some crucial things, like prescription drugs and long-term care.
  • You may want to purchase Medicare Advantage or Part D in order to cover any gaps in your insurance.

As you start to plan for your retirement, you may already know that Medicare Parts A and B will cover most of your health care expenses after you turn 65. Medicare Part A covers hospital stays, skilled nursing facility care, surgery, hospice and some home health care. Medicare Part B covers doctor’s visits, preventative care and some medical supplies. That’s all you need, right?

Not quite. There are many things that Medicare Parts A and B don’t cover. Luckily, there are other ways to cover these costs. Check out our full guide to Medicare and Medicaid for more information.

Prescription Drugs

Basic Medicare does not cover prescription drugs, although you can sign up to get coverage when you first sign up. You can either get a stand alone prescription drug plan, called Medicare Part D, or you can get a Medicare Advantage plan (often referred to as Part C), which will typically include prescription drug coverage.

Medicare Advantage and Medicare Part D both cost extra and are optional. But if you decide not to get Medicare Part D and later decide that you want it, you will be subject to extra fees tacked onto your premiums. These depend on how long you went without it.

With nine out of ten seniors taking prescription medications, and half of them (54%) taking four or more medications, it’s probably wise to sign for some kind of prescription drug coverage when it’s offered.

Long-Term Care

Medicare provides some coverage for skilled nursing facilities, but it doesn’t cover assistance with bathing, dressing, or other activities of daily life that you may need as you grow older. Medicare does provide for home health care, including physical therapy, but be sure you understand if and how you qualify. There are a number of strict rules you must meet, including being homebound and services must be given by a Medicare-certified home health agency.

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Deductibles and Copays

Medicare covers doctors visits, but first you must meet the deductible, and there’s still a co-pay involved every time you go to a doctor. For 2020, the annual deductible for Medicare Part A is $1408 while the annual deductible for Medicare Part B for is $198.

Routine Vision Care

Routine vision care and eyeglasses are not covered under Medicare. There are two exceptions to this:

  • Diabetics get a yearly eye exam
  • Eyeglasses after certain kinds of cataract surgery

Some Medicare Advantage plans provide for some vision care.

Hearing Aids

You will not be able to have Medicare cover the cost of either hearing aids or hearing exams. Even under Medicare Advantage, there’s a low cap on how much you can spend on hearing aids.

Most Chiropractic Services

Medicare Part B covers manual manipulation of the spine, if deemed medically necessary to correct subluxation of the spine (your bones are out of alignment). It will not cover any tests a chiropractor may order, such as X-rays, and it won’t cover acupuncture or massage therapy.

Routine Foot Care

Medicare Part B covers podiatrists, foot exams or treatment if you have diabetic neuropathy (diabetes-related nerve damage). It will also cover medically necessary treatment for things like bunions, hammertoes or heel spurs.

Most Dental Care

Medicare Part A will pay for certain dental services that you get when hospitalized. However, Medicare does not cover non-hospital dental care, cleanings, or dentures. Teeth can be exorbitantly expensive, with the average cost of dentures running around $1800, and a single implant can be $4500. Even with Medicare Advantage, the coverage is limited to cleanings, fillings, and bite-wing X-rays.

Bottom Line

Medicare Parts A and B have a lot of information to wade through. Should you enroll in Medicare Advantage, or just Medicare Part D? If you need help sorting out everything Medicare does and doesn’t cover and what to do about it, talk to a Certified Financial Planner at Retirable.

Author

Gail Kellner

Gail Kellner lives with her husband, two sons, and various fur-children. She writes about personal finance and insurance mostly, with a little bit of parenting thrown in. She also writes YA Fantasy fiction in her spare time, and her first YA novel will be published later this year.