When it comes to Medicare, many people are surprised to learn that it doesn’t cover everything. As you approach the age of 65 and prepare to enroll, it’s important to understand what Medicare will and won’t cover. Here are the seven main services that Medicare doesn’t include, so you can plan accordingly and avoid unexpected out-of-pocket costs.
1. Dental Care
Dental care is one of the biggest gaps in original Medicare coverage. Medicare doesn’t cover routine dental services like cleanings, fillings, or dentures. While certain dental services may be covered if related to a medical emergency (such as dental work needed before heart surgery), for the most part, you’ll need a separate dental plan. Some Medicare Advantage Plans (Part C) may offer dental coverage, but this varies depending on the plan.
2. Eyeglasses and Eye Exams
Original Medicare covers certain eye conditions, such as glaucoma screenings and cataract surgery. However, it does not cover routine eye exams, glasses, or contact lenses. If you need these services, you will likely need a Medicare Advantage Plan that includes vision coverage or a standalone vision insurance plan.
3. Long-Term Care
Medicare does not cover long-term care or custodial care, such as assistance with daily activities like bathing, dressing, or eating. If you need care in a nursing home for more than 100 days, you will have to pay out of pocket. Medicare will only cover skilled nursing care for up to 100 days in specific circumstances, and after the 20th day, you’ll face copayments.
4. Massage Therapy
Medicare does not cover massage therapy, even though it may offer relief for pain or stress. If you’re looking for therapeutic massage services, you’ll have to pay out of pocket or find another form of coverage.
5. Annual Physicals
While Medicare does cover an initial “welcome to Medicare” physical exam, it does not cover ongoing annual physical exams. Instead, you’ll receive an annual wellness exam, which is very basic and doesn’t include a comprehensive health check-up. If you need more extensive testing, it may come with additional costs.
6. Hearing Aids
At present, Medicare does not cover hearing aids or the fittings required for them, despite ongoing discussions about potential future changes. If you need hearing aids, you will have to pay for them out of pocket unless you have a Medicare Advantage Plan that offers hearing aid benefits, which vary depending on the plan.
7. Cosmetic Surgery
Medicare does not cover cosmetic surgery, such as tummy tucks or facelifts. The only cosmetic procedures Medicare may cover are those deemed medically necessary, such as reconstructive surgery following an accident or illness.
Conclusion
While Medicare offers broad coverage for essential medical services, it’s essential to be aware of the gaps. To fill these gaps, you may want to consider additional coverage options like Medicare Advantage Plans or Medicare Supplement Insurance (Medigap). These plans can help cover the costs of dental, vision, and hearing services, and may provide additional benefits that original Medicare does not. If you’re unsure about the best plan for you or want help exploring your options, our team at [Your Insurance Agency] is here to assist you in finding the right coverage. Contact us today for personalized guidance!
