Medicare is a lifeline for many seniors, providing essential health insurance backed by the federal government. However, it does not cover everything, leaving some unexpected out-of-pocket costs to beneficiaries.
Understanding these gaps is key to proper retirement planning. The following are seven important expenses that Medicare cannot cover.
1. Long Term Care Services
Long-term care, such as help with daily activities such as dressing or bathing, is usually not covered by Medicare. This includes care received in nursing homes, assisted living facilities, or home care services.
According to the Genworth Cost of Care Survey, the national average monthly cost of a private room in a nursing home is $9,733. Planning ahead with long-term care insurance or savings is important for those who may need these services.
2. General Vision Care
Original Medicare does not cover routine eye exams for glasses or contact lenses. Beneficiaries are responsible for the full cost of routine vision care, including exams and eyeglasses, unless they have a Medicare Advantage plan that offers vision benefits.
However, Original Medicare covers eye exams related to certain conditions such as glaucoma or diabetic retinopathy. For more information on Medicare coverage, visit the official Medicare website.
3. Dental Care
General dental services, such as cleanings, fillings, and dentures, are not covered by Original Medicare.
While some Medicare Advantage plans include limited dental coverage, beneficiaries in Original Medicare are responsible for 100% of dental care costs.
This gap can be large, especially for older people who need major dental work. Check out more information about what Medicare does and doesn’t cover on Medicare Interactive.
4. Hearing aids and tests
Hearing aids and the tests needed to fit them are not covered by Original Medicare, leaving beneficiaries paying out-of-pocket for these expensive devices. Diagnostic hearing tests to diagnose medical conditions may be partially covered, with the patient responsible for copays and deductibles.
For seniors who rely on hearing aids, considering additional insurance or saving on these costs is wise. Some Medicare Advantage plans may offer hearing aids, so comparing plan options is a good idea.
5. Chiropractic Care Beyond Manual Spinal Manipulation
Medicare Part B covers manual manipulation of the spine to correct subluxation when ordered by a physician, but other chiropractic services, such as diagnostic tests or maintenance care, are not included.
This means that regular visits to the chiropractor for preventive maintenance or general health will be out of pocket. Information about Medicare chiropractic coverage can be found at Medicare.gov.
6. Payments for certain parts of Medicare
Although Medicare offers subsidized coverage, it is not without cost. For example, beneficiaries must pay monthly premiums for Medicare Part B, which covers outpatient services.
n 2024, the average monthly premium for Part B starts at $174.70, with higher rates for those with higher incomes. Medicare Advantage plans may come with additional premiums on top of Part B costs.
Learn more about Part B premiums and costs on the Medicare.gov page.
7. Care Received Outside the US
If your retirement plans include international travel, be aware that Original Medicare offers limited coverage outside the US or its territories. This applies to treatment and prescription drugs purchased abroad.
While some Medicare Advantage plans may provide emergency services while you travel, you may want to consider purchasing additional travel insurance for full coverage. To find out more about what Medicare covers, visit the Medicare.gov site.
Prepare for the Unexpected
Understanding Medicare limits can help seniors plan for potential out-of-pocket costs and make informed decisions about additional insurance or additional savings.
Whether you’re considering long-term care insurance, exploring Medicare Advantage plans for additional coverage, or budgeting for regular health expenses, being proactive can lead to a financially secure and comfortable retirement.
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