Medicare won’t cover six major healthcare needs that could impact your budget greatly. You’ll need to pay out-of-pocket for long-term nursing home care, most dental services including dentures, routine vision care and eyewear, hearing aids and fittings, medical care outside the U.S., and prescription drugs under Original Medicare. Understanding these coverage gaps and exploring supplemental insurance options can help you better prepare for your future healthcare expenses.
Long-Term Care and Nursing Home Services
While Medicare provides essential health coverage for millions of Americans, it generally doesn’t cover long-term care or extended nursing home stays. You’ll need to pay out-of-pocket or secure separate long-term care insurance to cover these expenses.
Medicare will only cover short-term stays in a skilled nursing home facility for up to 100 days following a qualifying hospital stay. After that, you’re responsible for the costs.
Since nursing home care can exceed $100,000 annually, it’s vital to plan ahead for these potential expenses.
With annual nursing home costs reaching six figures, early financial planning becomes crucial for protecting your future well-being.
Consider exploring options like long-term care insurance policies, Medicaid qualification (if your assets are limited), or setting aside savings specifically for future care needs.
Speaking with a financial advisor can help you develop a strategy to protect yourself and your loved ones from substantial healthcare costs.
Medicaid home health care offers a cost-effective alternative for families seeking professional medical and personal care services tailored to individual needs.
Most Dental Care and Dentures
Despite being essential for overall health, routine dental care and dentures aren’t covered under Original Medicare (Parts A and B).
You’ll need to pay out-of-pocket for cleanings, fillings, extractions, and dentures unless you have supplemental dental insurance or a Medicare Advantage plan that includes dental coverage.
Medicare will only cover dental procedures if they’re medically necessary as part of a covered treatment. For example, if you need jaw reconstruction after an accident or oral examinations before kidney transplant surgery, Medicare may help with these costs.
To maintain your oral health without Medicare coverage, consider enrolling in a separate dental plan, joining a dental discount program, or choosing a Medicare Advantage plan with dental benefits.
These options can help you manage the costs of regular dental care and protect your overall well-being.
Fortunately, private pay options like personal checks, Zelle, and PayPal are available to help cover your dental care expenses.
Vision Care and Routine Eye Exams
Like dental care, vision coverage under Original Medicare is quite limited. You won’t receive coverage for routine eye exams, eyeglasses, or contact lenses. Medicare Part B only covers specific vision tests and treatments for eye diseases like glaucoma, cataracts, and macular degeneration.
To protect your eye health, you’ll need to explore additional vision insurance options. Consider enrolling in a Medicare Advantage plan that includes vision coverage or purchasing a separate vision insurance policy.
Meanwhile, follow essential eye health tips: maintain regular eye exams, protect your eyes from UV rays, eat a diet rich in vitamins A and C, and take screen breaks every 20 minutes.
If you notice any changes in your vision, don’t wait – contact an eye care professional immediately, as early detection of vision problems is vital.
For those requiring specialized care, Focus Family Care provides comprehensive medical support across eight Florida counties, including vision-related assistance through their skilled nursing services.
Hearing Aids and Fitting Services
Similar to vision care, Original Medicare doesn’t cover hearing aids or their fitting services. You’ll need to pay out-of-pocket for these assistive devices, which can range from several hundred to thousands of dollars per ear.
While Medicare Part B does cover diagnostic hearing tests if your doctor determines they’re medically necessary, it won’t help with the cost of hearing aids themselves or their maintenance.
If you’re concerned about hearing aid expenses, you might want to explore Medicare Advantage plans, as many of them offer coverage for hearing aids and fitting services.
You can also look into local hearing aid assistance programs, veteran’s benefits if you qualify, or financing options through hearing aid providers to help manage these essential healthcare costs.
Working with a service that provides medication management support can help ensure you stay on track with any prescribed hearing-related medications while managing your hearing aids.
Medical Care Outside the United States
When traveling abroad, you’ll find that Original Medicare generally doesn’t cover medical care outside the United States and its territories. You’ll need to pay out-of-pocket for any international medical services, including emergency care, unless you’re in specific situations like crossing through Canada between Alaska and another state.
To protect yourself while traveling, consider purchasing supplemental travel insurance that covers medical emergencies.
Some Medigap policies (specifically plans C, D, F, G, M, and N) offer foreign travel emergency healthcare coverage when you’re outside the U.S. However, these plans typically only cover 80% of emergency care costs and have a $250 deductible.
They also limit lifetime benefits to $50,000. If you frequently travel internationally, dedicated travel insurance can provide more thorough protection.
Experienced billing staff can help explain your Medicare benefits and confirm eligibility for various coverage options.
Prescription Drug Coverage Under Original Medicare
Original Medicare Part A and Part B provide limited coverage for prescription medications. You’ll receive coverage only for drugs administered during hospital stays or in outpatient settings under medical supervision. These typically include injections, infusions, or medications you can’t self-administer.
To help manage your prescription costs, you’ll need additional coverage through either a standalone Medicare Part D plan or a Medicare Advantage plan that includes drug coverage.
Medicare beneficiaries must enroll in Part D or Medicare Advantage plans with drug coverage to protect against high prescription costs.
Without one of these coverage options, you’ll likely pay full price for most prescription medications you take at home. This includes common drugs for chronic conditions like diabetes, high blood pressure, or cholesterol management.
It’s important to evaluate your medication needs and enroll in prescription drug coverage when you’re first eligible to avoid late enrollment penalties.
Conclusion
Medicare’s coverage has some important gaps you should know about – think of it like an umbrella with a few open spots that could leave you getting wet if you’re not careful. Many seniors find themselves needing extra care as they age, and it’s better to plan ahead than be caught by surprise. Having a clear understanding of what Medicare doesn’t cover helps you make smart choices about additional coverage you might need.
You’re not alone in figuring this out. Many families face the same questions and concerns about healthcare coverage for their loved ones. That’s why it’s so important to have caring experts on your side who understand these challenges and can guide you through your options.
If you or a loved one need help, don’t wait. Reach out to Focus Family Care today at (561) 693-1311 or email us at info@focusfamilycare.com.
