Original Medicare doesn't cover deductibles, copayments and coinsurance.
Original Medicare doesn't cover dental and vision coverage.
Original Medicare doesn't cover hearing aids.
Original Medicare doesn't automatically cover prescription drugs.
Original Medicare doesn't cover chiropractic treatment.
If you’re transitioning into retirement and new to Medicare, the health insurance benefits you once enjoyed through your employer’s group health insurance plan or previous health insurance plans may look a lot different with Medicare. At its core Original Medicare (Part A and Part B) will provide medical (doctor) and hospital coverage for what is deemed “medically necessary”, therefore it’s so important that you understand your Medicare coverage and actively manage your Medicare coverage your unique healthcare needs and budget. Medicare agents recommended an annual review your Medicare plan at least once a year, ideally during AEP (Annual Enrollment Period) between October 15 and December 7.
As you review your Medicare available Medicare coverage plans and options against your current healthcare needs and budget, here are the common 8 things Original Medicare generally DOES NOT cover:
1. Original Medicare Does Not Cover Deductibles, Copayments and Coinsurance
While you are likely to receive premium-free coverage for Medicare Part A (inpatient hospital related services), there are out-of-pocket costs to consider, including:
- Annual deductible
- Inpatient hospital deductible
- Inpatients hospital coinsurance (starts after day 60)
- Skilled nursing facility coinsurance (starts after day 20)
- Durable home medical equipment coinsurance (20% of cost)
- Inpatient respite care coinsurance (5% of Medicare-approved cost)
Once enrolled Medicare Part B, you will be likely paying for the following out-of-pocket charges:
- Monthly premium
- Annual deductible
Ways To Save: Beneficiaries may be able to offset costs by enrolling in a Medicare Supplement Plan or a Medicare Advantage Plan offered through federally approved private insurance companies.
2. Original Medicare Does Not Cover Dental Insurance and Dental Related Services
Basic dental care related services like x-rays, cleanings, and root canals along with dentures and implants are not covered by Original Medicare. There are certain medically necessary medical expenses where Original Medicare will cover some of the cost. For more information visit Medicare Coverage and Going to the Dentist .
Consider enrolling in a Medicare Advantage plan that has Dental coverage. Also some Medicare Supplement plans cover dental procedures and treatments in complicated situations or emergencies only, such as if a patient is hospitalized and needs oral surgery. Short of enrolling in a plan consider these other options:
- Ask for a payment plan: Many dentists may offer a payment plan for you to break up the costs over a few months.
- Consider financing: Specific credit cards are available to finance medical and dental procedures. Your dental provider can provide information on this type of financing.
- Go to a dental school: Some dental schools perform dental procedures at a low cost to the public as part of their dental training. Call a dental school near you to learn more.
3. Original Medicare Does Not Cover Vision Insurance and Eye Care
Original Medicare does not cover routine eye exams, glasses or contact, however, it will likely cover 80% of the costs relating to medically necessary services like cataract surgery.
Ways To Save: There are Medicare Advantage plans that offer vision benefits that cover eye exams, glasses and contacts.
4. Original Medicare Does Not Cover Hearing Insurance and Hearing Aids
Original Medicare doesn’t cover hearing aids regardless of circumstance. Even if a hearing exam is covered due to a potential underlying medical condition, the resulting recommendation of a hearing aid isn’t covered by Medicare.
Ways To Save: There are Medicare Advantage plans that offer benefits that cover hearing related needs. Another option to consider is buying a separate insurance plan or membership hearing discount plan.
5. Original Medicare Does Not Automatically Cover Prescription Drugs
Original Medicare does not cover prescription drugs except in certain medically necessary scenarios, like when a drug is administered during surgery.
Ways To Save: Prescription drug coverage can be obtained through enrolling in Medicare Part D and it is also an option offered in Medicare Advantage plans.
For more information visit Top 5 Tips for Shopping Medicare Part D Plans
6. Original Medicare Does Not Automatically Cover Assisted Living Facilities and Nursing Homes
The reason that assisted living facilities and nursing homes are not covered by Original Medicare is that the service is provided in a residential setting that provides custodial care, not medical care.
Ways To Save: Unfortunately, there aren’t simple solutions to address costs associated with long-term care scenarios involving living facilities and nursing homes. However, some options include taking out a long-term care insurance policy, selling a life insurance policy (life settlement), utilizing home equity or a reverse mortgage, and in some states Medicaid covers the care at assisted living facilities for seniors living in poverty.
For more information visit Does Medicare Pay for Assisted Living? and Medicare Coverage for Long-term Care Cost: What to Expect
7. Original Medicare Does Not Cover Medically Necessary Cosmetic Surgery
Medicare does supply health insurance coverage for reconstructive plastic surgery that is medically necessary. This would include the repair of damaged areas to the body resulting from trauma, injuries, developmental birth defects or serious diseases such as cancer. It may not cover elective cosmetic plastic surgery that is deemed medically unnecessary.
Ways To Save: Some investigative shopping can help on costs. Look into specials that doctors maybe offering for new patients or try booking your surgery during the summer when surgeons’ schedules are slow and they offer lower pricing. Bundling procedures can also help to reduce costs.
For more information visit Does Medicare Cover Cosmetic Surgery?
8. Original Medicare Does Not Cover Chiropractic Treatment
The coverage parameters for chiropractic care under Original Medicare are very narrow and if eligible it would likely be covered under Medicare Part B to correct a partial dislocation of a spinal vertebra from its normal position, otherwise known as spinal subluxation.
Ways To Save: There are Medicare Advantage plans that offer chiropractic care. Another option would include negotiating a payment play with the chiropractor.