7 Things Medicare Doesn’t Cover

Medicare Parts A and B, (original Medicare) cover a majority of your medical expenses after you turn 65 but I want to go over what it doesn’t cover.
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Medicare Part A (hospital insurance) helps pay for inpatient hospital stays, stays in skilled nursing facilities, surgery, hospice care, and even some home health care.   Medicare Part B (medical insurance) will help you pay for doctors visits, outpatient care, some preventive services, and some medical equipment and supplies.  Most people can start signing up for Medicare three months prior to the month they turn 65.

Medicare Part A and B have some significant gaps in coverage that all seniors should be aware of.   So I wanted to go over what isn’t covered by Medicare and go over supplemental insurance to fill in the gaps of Medicare Part A and Medicare Part B.

1. Prescription Drugs

​Medicare doesn’t provide any coverage for outpatient prescription drugs.   You can buy a separate Part D (prescription drug policy).   You can sign up for part D when you enroll in Medicare and you can change your Part D every year during open enrollment.  

2.  Long Term Care

Potentially the largest expense in retirement is the cost of long-term care.   2018 in Wisconsin the average cost in a nursing home per year was $112,146 (private room) and $51,600 for private room in an assisted living facility.  Medicare provides some coverage for skilled nursing services but not for custodial care.   You can buy long-term care insurance or a life insurance combination with long term care to help with these costs.  

3.  Deductibles and Co-pays

​Medicare Part A covers hospital stays and Part B covers doctors and outpatient care, but you are responsible for deductibles and co-payments.  In 2021 you will have to pay a Part A deductible of $1,484 before your coverage starts.   If you have a long hospital stay you will also be responsible for a portion of those costs. $371 per day for days 61-90 and $742 per day after that.   

Medicare Part B will cover 80%  of doctors services, lab tests, and X-rays but you are responsible for 20% of the costs after you meet your $203 deductible.   

Medicare Supplement or a Medigap policy are designed to fill in the gaps of Medicare.  These are sold by private insurance companies and if you buy one within six months of turning 65 you can not be denied coverage due to pre-existing conditions.  

4.  Most Dental Care

Medicare does not provide coverage for routine dental visits, fillings, teeth cleanings, dentures, and most teeth extractions.  If needed you can buy a stand alone Dental policy.   Medicare Advantage does provide some coverage for routine visits but generally have a coverage cap of $1500.

5.  Routine Vision Care

In general Medicare doesn’t cover routine eye exams or glasses.   There are some exception and they include an annual eye exam if you have diabetes or eyeglasses after having cataract surgery.   Some Medicare Advantage Plans provide vision coverage.   

6.  Hearing Aids

Medicare doesn’t cover routine hearing exams or hearing aids, which can cost thousands of dollars.   If you save money in an HSA before you enroll in Medicare you can also use that tax-free for hearing aids and other out of pocket expenses

7.  Medical Care Overseas

Medicare usually doesn’t cover care while traveling outside of the U.S.  There are very limited exceptions to this rule.   One is if you are on a cruise ship within 6 hours of a U.S. port.   Supplemental or Medi-Gap plans can cover 80% of emergency care, with a lifetime limit of $50,000.