medicare not cover
All You Need to Know Before Turning 65
Most people pay into Medicare through their payroll for all their employment years, thinking that once they turn 65, the coverage will be free. You'd be wrong to believe so. The truth about this health insurance program is that it also has several expenses.
High-income earners pay more in terms of copays, deductibles, and premiums, and expect no out-of-pocket maximum. A significant contributor to the misconception is the "Medicare for all" debate that leads consumers into believing that the program is entirely free.
What Does Medicare Cover, And What Doesn't It?
Here are the different areas that Medicare covers, those that it doesn't, and the appropriate solutions for the coverage gaps:
Eye Examination and Optician
Original Medicare covers ophthalmologic costs like cataract surgery. However, it doesn't cover contact lenses and glasses or routine eye checkups. Some people may opt to purchase a vision insurance policy, which costs several hundred dollars annually.
Hearing Aids
Medicare covers any ear-related condition. Unfortunately for hearing aids or routine checkups, the insurance program doesn't cover all these. If yours is the Medicare Advantage policy, check if the plan covers such needs. But if it doesn't, you may consider purchasing membership or insurance in discount plans covering such costs.
Dental Work
Both the Original Medicare and Medigap plans don't cover dental procedures like root canals, dentures, or routine checkups. Fortunately, several Medicare Advantage plans offer dental coverage. If your policy doesn't, purchase a dental discount policy or an individual insurance plan for dental care.
Overseas Care
A majority of Medicare Advantage plans in the United States and the Original Medicare don't cover any medical costs incurred outside the country. But there's a solution for frequent travelers. Several Medigap plans offer coverage for healthcare costs outside the U.S. What's more, several travel insurance policies provide this coverage, and you may also consider medevac (medical evacuation) insurance whenever you're planning an adventure abroad.
Podiatry
Medicare doesn't cover routine foot care like the removal of callus. Medicare Part B covers foot examinations and treatment provided it relates to nerve damage resulting from diabetes. It also covers care for foot ailments and injuries like heel spurs and hammertoe.
Cosmetic Surgery
Medicare doesn't cover elective cosmetic surgery. Procedures like tummy tucks and face-lifts aren't covered, but the plan covers plastic surgery to correct accidental injuries.
Nursing Home Care
Medicare covers limited rehab facility treatments. For instance, if you've undergone a hip replacement and thus require inpatient physiotherapy, your coverage will take care of the expenses. But if the condition worsens and needs to be transferred to a nursing home or an assisted living facility, the policy will not cover the custodial costs.
HMOs and Preventive Medicine
Health Maintenance Organization plans serve patients through a team of healthcare providers that agree to provide members with the services they need. The program covers a relatively wider diversity of preventive health services.
Members must select a PCP (primary care physician) to handle almost all their healthcare needs. Before visiting a specialist, you first have to be referred from your PCP. HMO plans are diverse, but their out-of-pocket healthcare costs are usually lower. You may need to pay a deductible before the beginning of the coverage, and the copayments are also low.
It's the ideal alternative if you are looking for lower premiums or if you need preventative care coverage like immunizations and checkups.
How to Keep Your Doctor and Ensure Coverage
You want to work with a health provider that you're comfortable with. They could be more familiar with your medical history or just a physician you can trust and share your information openly. This is a significant concern for most seniors, but is it possible once you enroll in Medicare?
If your coverage is Medicare Part B, you are free to visit your preferred physician if they accept a Medicare assignment. So if your preferred healthcare provider falls in this category, then you can easily stay with them. Medicare Part C, on the other hand, allows you to keep your physician. However, this depends on your particular Medicare Advantage plan and whether your specialist is in the network of providers.
Choosing A Medicare Supplement That Works for You
While Medicare health insurance may offer great coverage, it still doesn't cover all healthcare costs. If yours is the Original Medicare Plan and not the Medicare Advantage alternative, you can fill the gaps by acquiring a private supplemental insurance plan. Here are some crucial tips to finding a supplement plan for your healthcare needs:
- Analyze the available options – Medicare supplements are standardized and are used in any facility that accepts Medicare payments. You can choose from 10 currently available plans labeled alphabetically from letter A to N.
- Understand the pricing – After identifying the right plan, you'll proceed to shop, and the price is crucial for this. Don't just go for a plan because it's the cheapest as they are likely to raise the rates rapidly with time. You can choose between these three pricing categories: Attained-age rated, Issue-age rated, and Community-rated.
- Talk to an insurance broker – Never fear to seek help from an insurance broker whenever you're stuck. The law restricts them from charging a commission on the policy price. As such, you will end up paying the same premium as buying directly from the provider.
- Time is money – Immediately you turn 65, you'll be given seven months as the initial enrollment period. The duration comprises three months before you celebrate your birthday, the entire birthday month, and an additional three months afterward. During this period, you're assured of coverage with no underwritings. Once the time depletes, you can still acquire an appropriate Medicare supplement plan.
Medicare insurance plans are not entirely free, and you may have to pay some extra charges. Furthermore, the policy doesn't cover every healthcare service. But you can use different approaches to fix the coverage loopholes.