Even when you transition to Medicare, managing your healthcare expenses remains a critical aspect of financial planning, especially for those living on a limited income. Understanding the scope of Medicare coverage is essential to prevent unexpected medical bills. In this article, we’ll delve into the aspects of healthcare that Medicare doesn’t cover, shedding light on what you need to budget for and the options available to ensure comprehensive health coverage.
- Medically Unreasonable and Unnecessary Services and Supplies: This category includes excessive therapies, diagnostic procedures, exams, and treatments for which the patient has no symptoms or diagnoses. Alternative therapies, such as transcendental meditation, also fall under this category.
- Healthcare Costs for Spouses and Dependents: While employer coverage often includes family members, Medicare only covers the individual. Some individuals opt to maintain their employer plan to provide coverage for their spouse and children.
- Deductibles and Co-payments: Medicare comes with deductibles and co-payments that individuals are responsible for. In 2024, original Medicare members must pay a $1,632 Part A deductible, in addition to a $240 deductible for Part B.
- Long-Term Hospitalization: Original Medicare covers up to 90 days of hospitalization but involves deductibles and co-payments per benefit period. After 90 days, individuals dip into their “lifetime reserve days,” incurring higher co-pays.
- Dental, Vision, and Hearing: Routine dental exams, dental work, dentures, and routine vision care, including eye exams, eyeglasses, or corrective contacts, are not covered. However, Medicare Advantage plans may offer some vision and hearing coverage.
- Non-Medically Necessary Foot Care: Unless medically necessary, Medicare does not cover regular foot care services, including flat foot treatment, corn and callus removal, nail care, and orthopedic shoes.
- Nursing Home Care: Medicare does not generally cover long-term nursing home care. While in a nursing home, individuals still use Medicare for other services, such as hospital care and medical supplies.
- International Medical Care: Original Medicare typically does not cover care outside the U.S., except in limited cases, like care in U.S. territories or during a cruise within territorial waters touching U.S. land.
- Cosmetic Surgery: Medicare does not cover the costs of cosmetic surgery, with rare exceptions for procedures that serve therapeutic purposes.
- Prior Authorization: Many services, especially in Medicare Advantage plans, require prior authorization before members can access them. This includes specialist visits, out-of-network care, and certain non-emergency procedures.
It’s essential to understand what Medicare covers and what it doesn’t to effectively plan for healthcare expenses and avoid financial surprises. Depending on your specific needs, you may need to explore additional coverage options or consider Medicare supplements like Medigap plans to fill the gaps in your original Medicare coverage.