Beyond Medicare: 12 Unexpected Services You’ll Still Foot the Bill For

When it comes to healthcare, Medicare is a vital safety net for many seniors and eligible individuals. However, it’s essential to recognize that even with Medicare, gaps in coverage can catch you off guard. We’ve sifted through multiple reliable sources to compile this guide and shed light on the potential out-of-pocket costs you might face.

Eye Exams

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Medicare doesn’t include coverage for routine eye exams related to glasses or contact lenses. However, if you undergo cataract surgery, Medicare Part B will cover one pair of glasses or contacts (after the $240 deductible in 2024, you’ll pay 20% of the costs. To enhance vision coverage, consider exploring Medicare Advantage Plans that offer vision benefits.

Routine Dental Care

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Medicare Part A covers certain dental services during hospital stays but doesn’t extend to primary dental care like cleanings, X-rays, and fillings. Original Medicare and Medigap policies exclude dental work, dentures, and root canals. To secure dental coverage, you must purchase a separate dental policy. Alternatively, consider a Medicare Advantage Plan with Dental Benefits. Keep in mind that these benefits may have limitations or additional costs.

Hearing Aids

Medicare currently does not provide coverage for hearing aids or the necessary exams related to them. Although there is a provision in the Build Back Better Act that aims to include hearing aid coverage in Medicare, Congress has not yet approved this legislation. However, if your doctor recommends diagnostic hearing exams, Medicare does cover those.

Prescription Drugs

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Medicare (Part A and B) does not include coverage for prescription drugs. To obtain this coverage, you need to purchase a Medicare Part D plan from a private insurance company or opt for a Medicare Advantage Plan that includes medical and drug coverage. While drug coverage is optional, skipping it without any other creditable drug coverage may result in a late enrolment penalty if you decide to enroll later.

Foot Care

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Medicare Part B does not cover routine medical care for feet, such as flat foot treatment, corn and callus removal, nail care, and creams for foot skin care. If you regularly visit a podiatrist, you must budget for these appointments out of pocket unless they’re deemed medically necessary. However, Medicare does cover food exams or treatment if related to nerve damage due to diabetes, as well as care for foot injuries or ailments like hammertoe, heel spurs, and bunion deformities. Therapeutic shoes for people with diabetes, ulcer treatment, and foot care due to systemic disease are eligible for coverage.

Healthcare for Dependents

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Employer health plans often provide coverage for spouses and dependents. Medicare, on the other hand, is individual coverage. Some people choose to maintain their employer plan alongside Medicare to ensure continued coverage for their spouse and children. The decision allows them to balance their own needs with the well-being of their loved ones.

Long-term Hospitalization

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Medicare covers up to 90 days of hospitalization, with deductibles and copays. For each benefit period, you pay a $1,632 deductible. If your stay is 60 days or less, only the deductible applies. Between 60 to 90 days, you also pay a $408 co-payment per day. Beyond 90 days, you use your lifetime reserve days, incurring higher copays of $816 per day. Medicare doesn’t cover long-term care if it is the sole need. However, skilled nursing facility care is covered for the first 100 days after a qualifying three-day inpatient hospital stay.

Nursing Home Care

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Medicare pays for limited stays in rehab facilities (e.g., post-hip replacement therapy.) However, Medicare won’t cover custodial costs if you require assisted living or long-term nursing home care. Once admitted, you can’t drop your Medicare coverage while in a nursing home. Medicare still covers services like hospital care, medical supplies, and physician’s visits during your nursing home stay. Most nursing homes accept Medicaid, so dual-eligible individuals (receiving Medicaid and Medicare) are likely covered for admission. Some Medicare beneficiaries opt for separate long-term care insurance to cover this level of care.

 Oversees Healthcare

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When you’re outside the U.S., Medicare typically doesn’t cover health care or supplies, except in specific circumstances. For instance, Medicare may cover your care in Canada during a medical emergency, and a Canadian hospital is closer than a U.S. hospital. Otherwise, you’ll need to find supplemental coverage for travel or purchase insurance in the country where you reside. If you’re planning to move out of the U.S., it’s crucial to understand the implications of giving up Medicare. Returning to the U.S. and re-enrolling in Medicare later may result in Part B penalties. Keep this in mind before making any decisions. Additionally, while original Medicare generally doesn’t cover care outside the U.S., some Medigap plans will cover 80% of international medical costs. Specific Medicare Advantage plans may also provide necessary emergency medical coverage abroad.

Cosmetic Surgery

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Medicare typically does not cover cosmetic surgery such as facelifts or tummy tucks. However, it will cover plastic surgery in cases of accidental injury like burns or facial injuries or when needed after other treatments like breast reconstruction after mastectomy. When it comes to Medicare Advantage, preauthorization is often required for various services. These plans typically mandate prior authorization before members can see specialists or receive non-emergency treatments. Even if a service has been approved, it could be denied post-service if the necessary steps are not taken beforehand.

Chiropractic Care

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Medicare doesn’t cover most chiropractic services or related tests, including X-rays. Medicare Part B does cover the cost of manual manipulation of the spine when it is performed to correct a vertebral subluxation (a partial dislocation of a spinal vertebra from its normal position). You will need an official diagnosis and a qualified chiropractor to qualify for this coverage. Certain Medicare Advantage plans extend coverage to include chiropractic care.

Massage Therapy

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Medicare does not cover massage therapy, which is often used to help reduce chronic pain. If you receive therapeutic massage services from a massage therapist in the hospital or an outpatient setting, you will be fully responsible for covering the costs. Some Medicare Advantage plans might offer coverage for massage therapy. However, therapeutic massage therapy by a physical therapist as part of medical treatment is usually covered by Part B.

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