Medicare is important to millions of Americans who rely on it for their health and wellness, and as a primary source to help them with the ever-rising cost of healthcare. While Medicare provides much needed coverage for many, people are surprised to find that not all medical services are covered. Those who qualify for Medicare include all U.S. citizens and permanent residents 65 years of age and older and people with specified health conditions.
Knowing what Medicare does not cover can help keep you from receiving a surprise bill. The following items and services are some of those that Medicare will not cover.
- Hearing aids and routine dental exams. Hearing aids and routine dental exams are not covered by original Medicare (also called Medicare Part A and Part B); however, some Medicare Advantage Plans (Medicare Part C) and Medicare Supplement (Medigap) plans do cover them. To find out what Medicare does and doesn’t cover, visit medicare.gov/coverage.
- Treatment received outside the United States. If you travel a lot, it might be a good idea to look into a Medicare Supplement (Medigap) plan. Some of these plans will cover foreign travel emergencies.
- Long-term care. Medicare and most health insurance plans including Medicare Supplement (Medigap) insurance don’t pay for long-term (or “custodial”) care. Medicare only pays for medically-necessary skilled nursing facility care or home health care if you meet certain conditions (i.e. you were in the hospital for at least three days prior to coming to the facility, and the facility is Medicare-approved). According to Medicare, at least 70 percent of people over age 65 will need long-term care services at some point. That’s why it’s important to plan for long-term care early to make sure you get the care you need in the future. If you don’t want to use your personal savings to pay for long-term care, there are options including long-term care insurance through a private insurance company and your state Medicaid program.
- Alternative treatments and cosmetic surgery. Alternative treatments such as acupuncture, cosmetic surgery and other experimental treatments are not covered.
- Incidental costs. Costs associated with some types of medical treatments are not covered. For example: private rooms in a hospital or non-emergency transportation to get to a doctor appointment.
It’s important to remember that even if Medicare covers a service or item, you generally have to pay deductibles, coinsurance and copayments. Many people look at Medicare Advantage Plans (Part C) and Medicare Supplement (Medigap) plans to help with these out-of-pocket costs. A Medigap policy, for example, is health insurance sold by private insurance companies to fill the “gaps” between what Original Medicare covers and what you will have to end up paying yourself.
If you are still unclear about what Medicare will and will not cover, if you are a Health Advocate member, you can contact Health Advocate who can assist you and your family members with questions about Medicare benefits and options. Help is also available by calling Medicare at 1-800-MEDICARE (1-800-633-4227) or your State Health Insurance Assistance Program (SHIP). Go to http://www.medicare.gov/find-a-plan/questions/medigap-home.aspx.