By Deirdre R. Wheatley-Liss, LL.M, CELA
Medicare coverage is complicated and, as we saw in my blog post Medicare 101: What Medicare is and Who is Eligible, it is composed of several parts.
As you consider what parts of Medicare to enroll in, you should be aware of what Medicare covers and what it doesn’t cover. That way, you can plan carefully and be sure you are getting the health insurance and services that you need.
In my blog post Medicare 101: What Medicare is and Who is Eligible, I listed the various parts of Medicare and what each part covers.
While a complete list of what Medicare does not cover is too long for this blog post, it’s possible to make some general observations.
In general, Medicare does not cover the following:
- Co-Pays and Deductibles associated with Part A and Part B that are not covered. For this reason, many people opt to purchase a Medicare Supplement Plan or Medicare Advantage Plan which can cover some or all of the co-pays and deductibles that Medicare Part A and Part B do not cover.
- Home Health Care – i.e., assistance with activities of daily living – is not covered. Medicare is for inpatient (Part A) and outpatient (Part B) medical care only. While a handful of services administered in the home (a follow up visit by a nurse to clean and dress a wound or change a bandage, for example) may be covered, in general home health care services are not covered. To avoid billing surprises, it’s important to check with your provider regarding what services are covered by the Medicare coverage you have purchased.
- Long-term care is not covered (the exception being the partial coverage of 100 days in a skilled nursing facility – for rehab, for example, after a hospital stay). Long-term care, like home health care, falls outside the coverage which Medicare typically provides. A long-term care insurance policy can be purchased as a supplement to Medicare, however, to provide this coverage.
- Dental care is not covered (except, perhaps, if administered in a hospital setting). Routine dental care (exams, cleaning, fillings, dentures, etc.) is not covered. But if you’ve been in an accident, for example, which required a hospital visit, it’s possible that some of the dental work required to as part of your hospital treatment may be covered.
- Vision care (routine exams, glasses, contact lenses, etc.) is not covered. (But medically necessary treatment – for example, surgery for cataracts or treatment for glaucoma – is covered.)
- Hearing aids are not covered.
- Cosmetic surgery is not covered.
- Acupuncture is not covered.
- Medical care outside the United States is not covered. It is possible to purchase extra insurance for outside the U.S. from an insurance company (including, in some cases, as part of a Medicare Advantage or Supplement Plan). For more information on this, see my next blog post “Medicare 101: Medicare Supplement Plans and Medicare Advantage Plans.”
This post is for general informational purposes only. The specifics of your situation could affect your eligibility for Medicare and the specific benefits you receive. For a video presentation of this information, please visit Medicare 101: Maximizing Your or Your Loved One’s Health Care in Retirement. For more detailed information, please visit www.porzioplanning.com or contact us for a free 20 minute telephone consultation.
