Medicare covers the majority of older Americans’ health care needs, from hospital care and doctor visits to lab tests and prescription drugs. Here are some needs that aren’t part of the program — and how you might pay for them.
1. Dental work is rarely covered
Original Medicare covers some dental-related expenses in very specific situations.
- In 2023, dental exams and necessary treatments before organ transplant surgery were added.
- In 2024, Medicare started covering a dental exam as part of a comprehensive workup at the same time as Medicare-covered treatments for head and neck cancer.
But it doesn’t cover routine dental care, such as checkups, or big-ticket items, including dentures and root canals.
Solution: Some Medicare Advantage plans offer dental coverage. They focus on preventive services, with some covering a portion of the cost of more extensive care, up to an annual limit.
If you opt for original Medicare, consider buying an individual dental insurance plan or a dental discount plan. Some Medigap insurers allow you to add coverage or membership in a dental discount program for an extra premium.
2. Routine eye exams and glasses? No. Cataracts? Yes
While original Medicare covers ophthalmologic expenses such as cataract surgery, it doesn’t pay for routine eye exams, glasses or contact lenses. Some private Medicare Advantage plans cover routine vision care and glasses.??
Solution: For some people, buying a vision insurance policy for a few hundred dollars a year to defray the cost of glasses or contact lenses makes sense. Even though standard Medigap plans, the supplemental insurance available from private insurers to augment original Medicare coverage, don’t cover vision, some companies let you buy extra benefits that cover some in-network vision exams and a pair of glasses or contacts each year, up to an annual limit.
3. Hearing loss? You’ll pay for hearing aids yourself
Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids. ?
Solution: If you are in a Medicare Advantage plan, check your policy to see if it covers hearing-related needs. If it doesn’t, or if you have original Medicare, consider buying insurance or a membership in a discount plan that helps cover the cost of such hearing devices.
Also, over-the-counter hearing aids are now available for people with mild to moderate hearing loss.
4. Most chiropractors’ services won’t be covered
Original Medicare pays for just one chiropractic service: manual manipulation of the spine to correct a vertebral subluxation, which is a partial dislocation of a spinal vertebra from its normal position.
No other services or tests that a chiropractor orders are covered, including X-rays.
Solution: Some Medicare Advantage plans will cover chiropractic services, so check with your plan. Some chiropractors offer payment plans to help you pay for this care.
5. Bankroll elective cosmetic surgery yourself
Medicare doesn’t generally cover elective cosmetic surgery, such as facelifts or tummy tucks. It will cover plastic surgery after an accidental injury or if needed after another treatment, such as breast reconstruction following a mastectomy.
You may need prior authorization before Medicare will cover some procedures to show that it is medically necessary rather than for cosmetic purposes.
Solution: If you face these costs, you also may want to set up a separate savings program for them.
6. No massage therapy, even for chronic pain
Original Medicare doesn’t cover massage therapy, often used to help reduce chronic pain. Research suggests it may provide short-term, but not long-term, relief.
For pain management, Medicare does cover chiropractic care in certain limited circumstances (see above) as well as physical and occupational therapy when a doctor prescribes it.
Some Medicare Advantage plans might cover some massage therapy. It’s best to call your plan to find out.??
Solution: Ask your health care provider to recommend a pain management strategy that Medicare will pay for. If you are set on getting massage therapy, you’ll likely have to pay for it yourself.
Some acupuncture added! Medicare beneficiaries who have had lower-back pain for 12 weeks or longer now are able to get up to 20 acupuncture treatments each year. Allowing doctors, nurse practitioners, physician assistants and other qualified personnel to provide acupuncture to enrollees provides an alternative to prescription opioids to handle chronic pain, federal officials say.
7. You’re on your own for a podiatrist’s routine foot care
Routine medical care for feet, such as callus removal, is not covered. Medicare Part B does cover foot exams or treatment related to nerve damage because of diabetes or foot injuries or ailments, such as bunions, hammertoe and heel spurs.
Solution: If you face these costs, you may want to set up a separate savings program for them.
8. Add insurance to your dream vacation overseas
Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs outside the U.S.
Solution: Some Medigap policies cover certain overseas medical costs, typically paying 80 percent of the billed charges for specific medically necessary emergency care you receive outside of the U.S. after a $250 annual deductible. Medigap’s foreign travel emergency coverage has a lifetime limit of $50,000.
In addition, some travel insurance policies provide basic health care coverage — but they may exclude preexisting conditions, so check the fine print. Finally, consider medical evacuation, also known as medevac, insurance for adventures abroad. It will help pay to transport you to a nearby medical facility or back home to the U.S. in case of emergency.
9. Long-term care often comes out of your pocket
Medicare pays for limited stays in rehab facilities — for example, if you have a hip replacement and need inpatient physical therapy for several weeks. But if you need long-term help with the activities of daily living in a nursing home or assisted living center, you will have to pay the costs yourself.
Nursing homes average about $90,000 a year for a semiprivate room and more than $100,000 for a private room. Costs vary based on where you live and what place you choose.
Solution: Lots of decisions go into planning for nursing home care. Some people buy long-term care insurance, and others include these potential costs in their retirement plans.
Veterans may have access to some long-term care programs. For those with limited income and savings, Medicaid might help fill in the gaps.
10. If you want concierge care, you’ll pay extra
Some physicians and their practices require a membership fee. They advertise that this makes them more responsive and available to their patients. The fees, which can run in the thousands of dollars a year, vary depending on the concierge or boutique practice. Medicare will not cover these fees.
However, once you’ve paid that fee, if your doctor participates in Medicare, that physician must offer all the services Medicare does with the same copays and coinsurance rules.
Solution: You can either pay the fee or find another doctor. You might talk to your physician about the terms of when you have to pay. Some states have laws that provide consumer protections for these arrangements.
For more information about what’s not covered visit: https://www.medicare.gov/providers-services/original-medicare/not-covered
Source: AARP online
We hope this information is helpful to you in the important work you do as a family caregiver.
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