What Does Medicare Not Cover?

Doctors and patients sit and talk. At the table near the window in the hospital.

Medicare is designed to cover a range of medical costs you may face as you grow older. Unfortunately, these plans don’t cover everything, and some plans have more coverage than others.

Original Medicare vs. Medicare Advantage

As a government-mandated program, Original Medicare has certain limitations when it comes to coverage types and limits. A basic Original Medicare plan will only include Part A and Part B.

Medicare Advantage plans are offered by private insurers, so they offer a wider range and higher limits on Medicare coverage. These plans are known as Part C and often combine Part A, Part B and Part D. Part D Medicare covers prescription drug costs, which are not covered under Original Medicare.

Common Exclusions

As stated before, prescription drug costs are commonly excluded from Original Medicare plans. You may have to purchase additional coverage to receive assistance for your prescription drugs.

Services that are commonly excluded include dental and vision care. Coverage for dental and vision are usually left out from both Original Medicare plans, leaving you either without coverage or needing to purchase additional insurance.

Other exclusions include:

  • Hearing aids
  • Cosmetic surgeries
  • Long-term care
  • Acupuncture
  • Copayments
  • Deductibles

Almost any service that is not seen as medically necessary may not have coverage under a Medicare plan. When searching for a Medicare policy, it is important to consider your health needs and ask insurers about additional coverage options they may offer. While cosmetic procedures usually won’t have coverage, long-term care, dental and vision care may be covered under additional coverage or separate insurance policies. Unfortunately, dental and vision issues can have serious health risks on individuals if left unchecked. While some policies may not cover eyeglasses, you may be able to purchase additional coverage to cover the cost of eye exams, procedures, etc.

This is why many Medicare Advantage plans offer dental, vision and hearing care.

To cover expenses such as copays and deductibles, you may consider a Medigap policy.

What is Medigap Insurance?

A Medigap insurance plan is an extra policy you can purchase through a private insurer. This insurance helps cover the costs of copayments, deductibles and health care while you are traveling out of the country. Not all private insurers offer this additional insurance, so be sure to ask an agent about the coverage that is available for you.

What Medicare Plan Do I Need?

Everyone’s health care needs are different, which means your health insurance needs are different, too. It is important to speak with an insurance agent and your loved ones to discuss the best Medicare policy to benefit your health and your budget. Medicare shouldn’t be expensive, nor should you stress about not having to pay your premiums for plans with gaps in the coverage.

Medicare Advantage plans are not all created equal. If you have expensive prescription medication that would not be covered under a normal Medicare policy, you may need to add Part D. Some Medicare Advantage policies also cover delivery expenses to send prescription medication right to your mailbox instead of risking a trip to the pharmacy.

How Many People Does Medicare Cover?

While group health care plans exist for working individuals, Medicare operates differently. You cannot share your Medicare Advantage plan with multiple people, such as your spouse. Instead, you will each need a separate Medicare policy to cover your individual health needs. Keep in mind that even if you and your spouse have similar health conditions, your health can change drastically and quickly. Tailor your Medicare policy for your health needs.

Some individuals choose to have both Medicare and health insurance, however. If you qualify for both Medicare and Medicaid, you may receive more benefits and higher limits for your healthcare costs. Just keep in mind that, since these are two separate entities, you will have to pay separate premiums and deductibles.

What is Medicare Part C?

Medicare Part C is simply another name for Medicare Advantage plans. Medicare Part C combines:

  • Part A: Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice, lab tests, surgery and some home health care.
  • Part B: Medicare Part B covers durable medical equipment, outpatient care, home health services, tests, doctors’ services and some preventive services.

Some Medicare Advantage plans (unlike Original Medicare) may also include routine dental care, vision care, hearing care, hearing aids and fitness benefits. Routine and preventive care can be just as important to your overall health as other procedures, so be sure to ask your agent about ensuring that you are covered for routine care and preventive services.

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