The Medicare program is a federal health insurance program for people aged 65 and older, with specific disabilities, or with End-Stage Renal Disease. It provides coverage for hospital stays, skilled nursing care, physician services, physical therapy, and other medical supplies. Medicare has four parts—Hospital Insurance (Part A) which protects beneficiaries against the financial consequences of hospitalization. Medical Insurance (Part B) which protects beneficiaries against the financial consequences of a physician, outpatient hospital, medical supplies, and preventive services. Part C is a voluntary program for prescription drug plan coverage, and Part D covers self-administered prescription drug plans. Let’s review what Medicare will not cover:
1. Prescription drugs
Medicare does not provide prescription drugs for outpatients. Under Medicare, if you pay more than $1,235 per year for doctor’s services, you must pay a monthly cost-sharing amount for your Part D prescription drugs. Part D is a prescription drug plan; you must enroll in it if you want prescription drug coverage.
2. Overseas health care
Medicare doesn’t cover overseas health care, so you must know what your program will and won’t cover, especially if you have pre-existing conditions. The law states that Medicare will only cover medical expenses incurred overseas if an individual travels to one of the 29 countries with bilateral healthcare agreements with the U.S. Alternatively, United AARP Medicare plans cover medical expenses for limited circumstances, for example, if you need medical attention and are on a ship within six hours of a U.S. port.
3. Routine eye exams
Medicare doesn’t cover routine eye exams within the first six months of diagnosis, costing up to $400 out-of-pocket. Upon diagnosis, Medicare will pay for any additional exams needed within the first year of diagnosis. At that point, the patient will be subject to copays and specific fees not covered by Medicare.
4. Hearing aids
Medicare doesn’t cover hearing aids. In addition, Medicare will not cover over-the-counter medications used to treat hearing loss. However, ear molds are covered if a doctor or audiologist initially prescribed them. Hearing aids are covered as long as you receive one of the following: Medicaid, United Healthcare Medicare, Supplemental Security Income, or Social Security Disability Insurance. Medicare will not automatically cover your hearing-aid costs unless you have one of the abovementioned programs.
5. Routine dental exams
Medicare will not cover routine dental care, such as regular cleanings, sealants, or pulp therapy.If you have periodontal disease or have lost all or part of your tooth due to injury or illness, Medicare may cover treatment related to the problem. You may also be covered for a root canal if you need one because of injury or disease and if your tooth is an upper anterior tooth. Medicare Advantage plans cover certain services like dental cleanings and X-rays, but they are usually limited to an annual coverage cap of about $1,500.
6. Deductibles and coinsurance
Medicare doesn’t cover deductibles and coinsurance. Medicare will help you with out-of-pocket costs like copays, but it doesn’t have a monthly limit on them. Once your monthly fee reaches the deductible, Medicare will start paying 100% of the approved amount. In most cases, you’re responsible for paying the balance. Support plans may have a lower or higher deductible. The coinsurance rate is the percentage of seniors responsible for medical services after they have met their deductible. It can be as high as 50% to 80%.
7. Long term care
Home Care is a popular choice for seniors who have become ill or have a chronic health condition that requires their care. Under the law, Medicare will cover certain home care costs: like transporting seniors to and from medical appointments and arranging meals and cleaning services. However, Medicare does not cover long-term care services like assisted living or nursing homes. There are alternatives for those looking for coverage under the law, such as
Long Term Care Insurance, which is a long-term care insurance plan that you can purchase to cover your expenses should you ever require long-term care. As well as assisted living facilities and nursing homes, which offers residents long-term care without requiring them to have LTC coverage. This option is a good place for those with children who can help pay their expenses or those who need more time to be ready to commit to LTC insurance. Additionally, Medicare benefits are covered effectively under the law.