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What Medicare Covers—and What It Doesn’t

October 21, 2021
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Turning 65 means you’re now eligible to receive Medicare benefits. But sorting through the Medicare alphabet can be challenging. How do you get started and what do you need to know before you enroll? The first step is to visit the government’s Medicare website, which provides a step-by-step guide for choosing the options and coverage you need. Keep in mind that different parts of Medicare cover specific services.

What Medicare Covers

  • Part A hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, and home healthcare.
  • Part B medical insurance covers doctor and other healthcare providers' services, outpatient care, durable medical equipment, home healthcare, and some preventive services.
  • Part C, a Medicare Advantage Plan, is a Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Most plans offer extra coverage, like vision, hearing, dental, and/or health and wellness programs, as well as prescription drug coverage (Part D). In addition to your Part B premium, you usually pay a monthly premium for the Medicare Advantage Plan.
  • Part D is prescription drug coverage, which can also be obtained through a Medicare Advantage Plan offering Medicare prescription drug coverage.
  • Medigap, or Medicare Supplement Insurance, helps pay some of the healthcare costs that Medicare Parts A and B don’t cover, like copayments, coinsurance, and deductibles.

If you have Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered healthcare costs first, then your Medigap policy will pays its share of the remaining costs.

Medicare Parts A and B don’t cover:

  • Outpatient prescription drugs. However, you can purchase a separate Part D prescription-drug policy or a Medicare Advantage plan that covers both medical and drug costs. (Some retiree healthcare policies cover prescription drugs, too.)
  • Dental care, including routine dental visits, teeth cleanings, fillings, dentures, or most tooth extractions. Some Medicare Advantage plans cover basic cleanings and X-rays, but they generally have an annual coverage cap.
  • Routine eye exams, glasses, and contact lenses. Exceptions include an annual eye exam if you have diabetes or eyeglasses after having certain kinds of cataract surgery. Some Medicare Advantage plans provide vision coverage, or you may be able to buy a separate supplemental policy that provides vision care alone or includes both dental and vision care.
  • Routine hearing exams and hearing aids, which can cost several thousand dollars. Some Medicare Advantage plans cover hearing aids and fitting exams, and some discount programs provide lower-cost hearing aids.
  • Medical costs incurred outside the U.S., except in very limited circumstances. Some Medicare Advantage plans cover emergency care abroad and certain Medigap plans cover up to 80% of services received outside of the U.S.
  • Long-term care services, including assisted living, home health aides, and institutional and nursing home costs. Keep in mind, costs can vary greatly by state and region.

While this isn’t a complete list of items and services that are not covered under original Medicare, it does provide insight into how healthcare costs can add up to hundreds of thousands of dollars over the course of 25 or 30 years in retirement. If you have questions about what Medicare options are right for you, contact the office today to schedule time to talk.

This communication is designed to provide accurate and authoritative information on the subjects covered. It is not, however, intended to provide specific legal, tax, or other professional advice. For specific professional assistance, the services of an appropriate professional should be sought.