11 Unexpected Things Medicare Doesn’t Cover
by Kate Daugherty | Originally posted on Finance Buzz
Medicare helps millions of people, but it doesn’t cover everything. Discover some surprising things that Medicare doesn’t cover so you don’t get a nasty shock.
Medicare offers health care coverage to almost 64 million people and accounts for 4.36% of the United State’s gross domestic product (GDP), totaling $917 billion in 2020. With such a large amount of money spent, many people think that the program covers all health care costs for seniors and those with disabilities.
Unfortunately, that’s not the case. Original Medicare (Parts A and B) only covers specific services and procedures, leaving common medical expenses like dental, vision, and medical care outside the US uncovered.
When you become eligible for Medicare at age 65, you may think that you won’t have to worry about health care expenses as you get older. Finding out that certain things aren’t covered can be a rude awakening. Knowing what is and is not covered is essential since it helps you budget for potential health care costs after joining Medicare.
Let’s look at some of the things Medicare doesn’t cover to help you be prepared for retirement.
1. Deductibles and co-pays
Like any insurance policy, Medicare Parts A and B have deductibles that participants are responsible for. Part A covers hospital stays, and in 2022, you’ll be responsible for a deductible of $1,556 for each hospital stay before Medicare coverage begins. If you stay in the hospital for more than 60 days, you may also be responsible for a portion of the costs: $389 for days 61-90 of hospital stays. Your 90-day cycle will reset when you are discharged, and any readmittance will require another $1,556 deductible.
Medicare also has “lifetime reserve” days, which cover an additional 60 days of inpatient care once during your life. If your hospital stay goes beyond 90 days, you’ll use your lifetime reserve days to increase coverage. After you’ve used your lifetime reserve days, you’ll pay the coinsurance rate of $778 per day for every day you’re in the hospital past the initial 90 days.
Part B, which covers doctor’s visits and outpatient services like labs, medical equipment, and X-rays, has a monthly premium of $170.10 in 2022 if your adjusted gross income is $91,000 or less. You either pay this premium directly to Medicare or have it deducted from your Social Security benefits once you apply for those. Part B generally covers about 80% of your costs, meaning you’ll have to cover the remaining 20% and the annual $233 deductible.
2. Prescription drugs
Accurately budgeting for your monthly prescription costs can take some stress out of retirement planning. Original Medicare (Parts A and B) doesn’t offer prescription coverage, but you can add drug coverage under Part D for an additional cost when you sign up for Medicare. You can also add Part D drug coverage later, although you may pay a monthly penalty for delaying. The cost of Part D is based on the amount and type of coverage you choose.
You can buy a Medicare Advantage plan, often called Part C, where prescriptions are usually included along with Parts A and B. Some Advantage policies also provide additional supplemental insurance to help cover the gaps in Original Medicare. Premiums for Part C are based on the amount of coverage you choose, so make sure you understand the ins and outs before you sign up.
3. Dental
Medicare doesn’t cover most dental services, like cleanings, fillings, X-rays, or dentures. While Medicare Part A will pay for certain dental services you receive while in the hospital, most people are on their own for regular dental care. Many Medicare Advantage plans offer dental coverage that may include preventive and diagnostic services only, like exams, X-rays, and routine cleanings. Some also offer comprehensive coverage, including preventive services and dental procedures like fillings, crowns, root canals, and dentures or implants.
Pro tip: If you have a high-deductible health plan, check if you have access to a Health Savings Account (HSA). HSAs allow you to save money for relevant medical expenses in retirement, including dental services, and the funds can be withdrawn tax-free for qualifying expenses. Note that you can’t contribute to a Health Savings Account after applying for Medicare, so it's best to start early.
4. Hearing
Hearing exams or hearing aids aren’t covered under Original Medicare, but Medicare Advantage plans may offer at least partial coverage of these items to help offset the cost. As people with hearing loss know, hearing aids can be expensive, with some units costing $6,000 and up for both ears, plus the cost of fittings, exams, and other related services.
Even diagnosing and treating things like tinnitus (ringing in the ears) is usually not covered by Medicare and may not be covered by Medicare Advantage plans either. Part B may cover a diagnostic hearing test or balance exam if your doctor orders them to see if you need treatment for a medical issue.