Medicare covers the majority of older Americans’ health care needs, from hospital care and doctor visits to lab tests and prescription drugs. Here are some needs that aren’t part of the program — and how you might pay for them.
- Opticians and eye exams
While original Medicare does cover opthalmologic expenses such as cataract surgery, it doesn’t cover routine eye exams, glasses or contact lenses. Nor do any Medigap plans, the supplemental insurance that is available from private insurers to augment Medicare coverage. Some Medicare Advantage plans cover routine vision care and glasses.
Solution: For some people, it makes sense to buy a vision insurance policy for a few hundred dollars a year to defray the cost of glasses or contact lenses.
- Hearing aids
Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids.
Solution: If you are in a Medicare Advantage plan, check your policy to see if it covers hearing-related needs. If it doesn’t, or if you have original Medicare, consider buying insurance or a membership in a discount plan that helps cover the cost of such hearing devices. Also, some programs help people with lower incomes to get needed hearing support. Or you can pay as you go. Congress passed legislation in 2017 that allows some hearing aids to be sold over the counter without a prescription. Medicare beneficiaries with mild to moderate hearing loss can now buy hearing aids at drugstores and other retail outlets without a prescription.
- Dental work
Original Medicare and Medigap policies do not cover dental care such as routine checkups or big-ticket items, including dentures and root canals.
Solution: Some Medicare Advantage plans offer dental coverage. If yours does not, or if you opt for original Medicare, consider buying an individual dental insurance plan or a dental discount plan.
- Overseas care
Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs incurred outside the U.S.
Solution: Some Medigap policies cover certain overseas medical costs. If you travel frequently, you might want such an option. In addition, some travel insurance policies provide basic health care coverage — so check the fine print. Finally, consider medical evacuation (aka medevac) insurance for your adventures abroad. It’s a low-cost policy that will transport you to a nearby medical facility or back home to the U.S. in case of emergency.
- Podiatry
Routine medical care for feet, such as callus removal, is not covered. Medicare Part B does cover foot exams or treatment if it is related to nerve damage because of diabetes, or care for foot injuries or ailments, such as hammertoe, bunion deformities and heel spurs.
Solution: If you face these costs, you may want to set up a separate savings program for them.
- Cosmetic surgery
Medicare doesn’t generally cover elective cosmetic surgery, such as face-lifts or tummy tucks. It will cover plastic surgery in the event of an accidental injury or if needed after another treatment, such as breast reconstruction following a mastectomy.
Solution: If you face these costs, you also may want to set up a separate savings program for them.
Limited acupuncture coverage: Medicare has added coverage for acupuncture for enrollees with chronic low-back pain. Beneficiaries who have had lower-back pain for 12 weeks or longer will be able to get up to 20 acupuncture treatments each year.
Allowing doctors, physician assistants, nurse practitioners and other qualified personnel to provide acupuncture to these beneficiaries is one alternative, federal officials say, to the increasing use of prescription opioids to handle chronic pain.
- Chiropractic care
Original Medicare does not cover most chiropractic services or the tests that a chiropractor orders, including X-rays. Medicare Part B does pay for one manual manipulation of the spine by a chiropractor or other qualified provider to correct a vertebral subluxation, which is basically a partial dislocation of a spinal vertebra from its normal position.
Solution: Some Medicare Advantage plans will cover chiropractic services, so check with your plan. Some chiropractors offer payment plans to help you pay for this care.
- Massage therapy
Original Medicare doesn’t cover massage therapy, often used to help reduce chronic pain, although research suggests it may provide short-term, but not long-term, relief. When it comes to pain management, Medicare does cover chiropractic care in certain limited circumstances (see above) as well as physical and occupational therapy when prescribed by a doctor. Some Medicare Advantage plans might cover some massage therapy. It’s best to call your plan to find out if it does.
Solution: See whether your health care provider can recommend a pain management strategy that Medicare does cover. If you are set on getting massage therapy, the likelihood is you’ll have to pay for it yourself.
- Nursing home care
Medicare pays for limited stays in rehab facilities — for example, if you have a hip replacement and need inpatient physical therapy for several weeks. But if you become so frail or sick that you must move to an assisted living facility or nursing home, Medicare won’t cover your custodial costs. (Nursing homes average about $90,000 a year for a semiprivate room and more than $100,000 for a private room. Costs vary based on where you live and what facility you choose.)
Solution: Planning for nursing home care is a big issue, with lots of choices and decisions. But for those with limited income and savings, Medicaid might help fill in the gaps.
- Concierge care
Some physicians and their practices require a membership fee in order for them to treat you. They advertise that this makes them more responsive and available to their patients. The fees, which can run in the thousands of dollars a year, vary depending on the concierge or boutique practice. Medicare will not cover these fees. Note that once you’ve paid that fee, if your doctor participates in Medicare he or she must offer all the services Medicare does with the same copays and coinsurance rules applying.
Solution: You can either pay the fee or find another doctor. You might talk to your physician about the terms of when you have to pay. Some states have laws that provide consumer protections for these arrangements.
The article is originally published on AARP, and has be shared for the information of BenefitsByState subscribers.
