Despite its extensive coverage, Medicare does have limitations. Many enrollees are surprised that some essential services and medications aren’t part of their Medicare benefits. For example, routine dental care, vision exams, and hearing aids are typically not included. And even if you have Medicare Part D, be aware of coverage gaps in the prescription drug plans.
To ensure you’re well-prepared, it’s crucial to be aware of these gaps. Understanding these nuances can save you from unexpected out-of-pocket expenses and help you plan better for your healthcare costs. Our team at McKnight & McKnight Insurance Solutions discusses what falls outside Medicare’s coverage and shares your options for bridging these gaps effectively.
What Does Medicare Not Cover?
Understanding what isn’t covered in Medicare is crucial for planning your healthcare needs precisely. Some services and items not covered include:
- Medically unreasonable and unnecessary services and supplies
- Health care costs for spouses and dependents
- Deductibles and co-payments
- Long-term hospitalization
- Dental and non-medically necessary vision and hearing
- Non-medically necessary foot care
- Nursing home care
- International medical care
- Cosmetic surgery
Medically Unreasonable and Unnecessary Services and Supplies
Medicare will not cover services and supplies deemed medically unreasonable and unnecessary. This can include tests and procedures that aren’t essential for diagnosing or treating a condition, thereby not meeting Medicare’s standards for medical necessity.
Health Care Costs for Spouses and Dependents
Healthcare costs for spouses and dependents are not covered by Medicare. Medicare benefits only apply to the individual who has qualified for and enrolled in the program.
Deductibles and Co-payments
While Medicare does cover a wide array of services, beneficiaries are still responsible for deductibles and co-payments. These out-of-pocket costs can add up, so it’s crucial to budget accordingly.
Long-Term Hospitalization
Long-term hospitalization is also not covered under Medicare. Generally, Medicare covers hospital stays up to 90 days per benefit period, with additional costs for stays beyond that range.
Dental and Non-Medically Necessary Vision and Hearing
Coverage for dental, non-medically necessary vision, and hearing services is limited. Routine check-ups, eyeglasses, hearing aids, and other related services typically need to be financed out-of-pocket or through supplementary insurance plans.
Non-Medically Necessary Foot Care
Non-medically necessary foot care, such as routine podiatry visits, is not covered. Medicare only covers foot care when it is medically necessary, such as in cases of diabetes.
Nursing Home Care
Nursing home care, particularly long-term custodial care, isn’t covered by Medicare. This includes assistance with daily living activities such as bathing, dressing, and eating, which are considered non-medical.
International Medical Care
International medical care is another category where Medicare coverage falls short. If you plan to travel outside of the United States, you’ll need alternative health insurance to cover medical expenses incurred abroad.
Cosmetic Surgery
Cosmetic surgery aimed at improving appearance is not covered. Exceptions are made only if the surgery is necessary due to accidental injury or to improve the function of a malformed body part.
Tip: Planning for these gaps can ensure that you aren’t caught off guard by unexpected healthcare costs. Considering supplemental insurance or alternative coverage options could be beneficial. Be sure to review your options with a knowledgeable insurance agent.
“I have used McKnight & McKnight for many years and Bob and Heather have been very helpful with our insurance needs. He helped both my husband and myself navigate starting our Medicare journey. We are self-employed and he also has helped us with private insurance prior to starting Medicare. We would highly recommend.”
-Susan
How McKnight & McKnight Insurance Solutions Can Help
Understanding the ins and outs of what Medicare does and doesn’t cover can be stressful. This is where our independent insurance agents at McKnight & McKnight Insurance Solutions step in. We are committed to helping you navigate these complexities so that you can make the most informed decisions regarding your healthcare coverage.
Personalized Assistance: We offer personalized assistance tailored to your unique needs. We understand that healthcare is not one-size-fits-all, and we work closely with you to determine the best plan options that suit your specific circumstances.
Expertise in Gaps and Supplemental Coverage: One of our primary focuses is to educate you on the potential gaps in Medicare coverage and how these can be addressed. For instance, if prescription drug costs are a concern, our agents can guide you through options that are available to you to supplement your coverage.
Maximizing Benefits: We also help you understand how to maximize your benefits. For example, during the Coverage Gap Stage in Medicare Part D plans, you might consider switching to generics or other lower-cost drugs, which could result in significant savings before entering Catastrophic Coverage.
Staying Ahead of Changes: Keeping up with changes in Medicare can be challenging, but our agents stay informed on the latest updates. For instance, come 2025, the Coverage Gap Stage will no longer be a part of Medicare Part D plans. We keep you ahead of these changes, ensuring your coverage adapts to the evolving landscape of healthcare.
Read More > When Do I Apply for Medicare?
Lean on Our Independent Agents
Choosing McKnight & McKnight Insurance Solutions means partnering with a team that prioritizes your health and financial well-being. We’re here to support you every step of the way, making sure you fully understand your options and can confidently make decisions that are best for you.
Contact us for a comprehensive Medicare evaluation today.
