Many people preparing to enroll in Medicare go in assuming it will cover most of their health care needs. While the program does provide broad coverage, it doesn’t pay for every service or expense, including some key services people often need as they age. As a result, gaps in coverage can lead to unexpected out-of-pocket costs. Before you enroll in a Medicare plan, take some time to learn what Medicare doesn’t cover so you can plan ahead and explore ways to manage those expenses.
What Does Medicare Not Cover?
While Original Medicare focuses primarily on hospital care and medically necessary services, many routine or ongoing health needs fall outside the program’s standard benefits. As a result, beneficiaries may encounter expenses that Medicare won’t pay for. The following services and types of care are some of the most common coverage gaps:
- Routine Dental Care – Original Medicare generally doesn’t pay for cleanings, fillings, extractions, dentures, or routine dental exams. While certain dental procedures performed in a hospital setting may be covered in limited circumstances, individuals must pay out of pocket for most standard dental care.
- Routine Vision Care – Medicare usually doesn’t cover routine eye exams for glasses or contact lenses, nor does it pay for the glasses or contacts themselves. Some medical eye conditions may be covered, but standard vision care often requires separate coverage.
- Hearing Aids and Hearing Exams for Fitting Them – Hearing aids can be expensive, and Original Medicare usually doesn’t cover the devices or the exams used to fit them. Beneficiaries often must pay the full cost unless they have additional coverage.
- Long-Term or Custodial Care – Medicare doesn’t pay for most long-term care services, such as extended nursing home stays or assistance with daily activities like bathing, dressing, or eating when this is the primary type of care a person needs.
- Medical Care Received Outside the United States – In most situations, Medicare doesn’t cover care received while traveling abroad, which can leave beneficiaries responsible for the full cost of treatment outside the country.
Options for Plugging Gaps in Your Medicare Coverage
Coverage gaps like these can create real concerns about out-of-pocket costs. For this reason, many Medicare beneficiaries choose additional coverage to help manage these expenses. While they work differently, two common options that can help address some of the limits in Original Medicare are Medicare Supplement insurance (Medigap) and Medicare Advantage plans.
Medigap policies are designed to work alongside Original Medicare. They do so by helping to pay certain out-of-pocket costs that Medicare doesn’t cover, such as deductibles, copayments, and coinsurance. Some Medigap plans can also help people who travel internationally by including limited coverage for emergency medical care outside the United States. However, Medigap policies generally don’t include additional benefits like routine dental, vision, or hearing care.
Medicare Advantage (Part C) plans, on the other hand, are offered by private insurance companies and replace Original Medicare as your primary coverage. Many Medicare Advantage plans include benefits that Original Medicare doesn’t provide, such as routine dental services, vision exams, hearing benefits, and prescription drug coverage. These plans combine several types of coverage into one policy to help address some of the gaps left by Original Medicare.
Which option is right for you? It all depends on your health needs, your budget, and your coverage preferences. Review the available plans to see how they differ and determine which approach fits your situation.
Talk to Roses Insurance Group About Your Medigap Options
Are you confused by Medigap and Medicare Advantage options available to you as an Arizona resident? Roses Insurance Group can help you understand their respective pros and cons and how they might help you more comfortably pay for your health care. Reach out to our Tucson insurance agency today to schedule an appointment.