Medicare is a comprehensive health insurance program that caters to most of your healthcare needs. However, it’s essential to understand what Medicare does cover to prevent disappointment or unexpected delays to your care. In this informative blog, we will explore four essential health services that Medicare does not cover and offer valuable strategies to help you access the care you need.
Medicare is a double-edged sword. On one side, it encompasses a wide range of health services, yet on the other, it leaves a gap in dental care, vision tests, hearing aids, and long-term care. Knowing how to traverse these gaps independently could be a potential lifesaver.
Does Medicare Cover Dental?
Medicare’s dental coverage can be confusing. Original Medicare (Parts A & B) doesn’t cover most dental procedures, such as fillings, root canals, extractions, and dental prosthetics (crowns, bridges, dentures). However, Medicare will chip in if you have severe conditions or require major operations like heart valve replacement or kidney removal. Medicare acknowledges the role of pre-surgical dental assessment in these interventions. Likewise, jawbone resections due to jaw cancer that involve dental reconstruction are covered.
Medicare Dental Coverage
Given the limitations of Medicare dental coverage, the logical question is how to cover your dental needs under Medicare. Here are three options:
- Medicare Advantage Plans (Part C): Designed by private insurance companies, these plans offer dental allowances. Generally, allowances range from $1000-$4000 annually and are subject to network dentist availability and deductibles.
- Stand-alone Dental Insurance: An effective countermeasure to Medicare’s limitations, these plans cover preventive services, basic services, and major services at varying proportions. Premiums can vary depending on where you live and often provide reimbursement for major dental concerns.
- Pay ‘Out-Of-Pocket’: If your oral health is in good condition and you only need occasional routine checkups, this could be a smart way to save your hard-earned money.
Does Medicare Cover Vision?
Taking care of your vision health is essential for overall health maintenance. Unfortunately, Medicare does not cover routine eye examinations unless there is a medical necessity. However, Medicare does cover vision treatments for eye conditions such as refractive errors, cataracts, glaucoma, macular degeneration, and diabetic retinopathy.
Medicare Vision Coverage
Vision typically declines as you age so having vision coverage to supplement your Medicare plan is important. Luckily you have a few options to get the coverage you need:
- Medicare Advantage Plans: This coverage is often bundled into your Advantage coverage and typically pays for routine eye exams, many excluding eye dilation, and reimbursement for eyewear purchases.
- Purchase Vision Insurance: VSP and EyeMed insurance plans provide comprehensive coverage for annual eye examinations and offer credits for eyewear purchased. The plan will vary between providers, allowing you to choose the one that best suits your needs and budget.
Does Medicare Pay for Hearing Aids?
Regrettably, Medicare does not provide coverage for hearing aids or the assessments required to fit them, although proposals are currently being considered to address this issue.
Coverage Options for Hearing Aids
If you call into the population of seniors in need of hearing aids, here are a few coverage solutions:
- Medicare Advantage Plans: These plans lead the way in hearing coverage with audiology networks and hearing aid coverage via copays.
- Stand-alone Hearing Plans: These plans can provide significant discounts and trial periods.
- Purchase Hearing Aids OTC (Over The Counter): This has become a more popular option over the years due to new legislation.
Does Medicare Cover Long-Term Care?
Medicare does not cover long-term care because it prioritizes coverage for essential medical services that have a greater chance of leading to recovery. The majority of long-term care consists of custodial services which assist with daily tasks like bathing, eating, and dressing. Medicare may cover some services if they are related to a covered service.
Long-Term Care Coverage Solutions
If you have a chronic illness or have a family history of chronic illness, it’s best to look into coverage options for long-term care. Here are a few ways to go about this:
- Purchasing Long-Term Care Insurance: Offers good coverage and is available from many providers.
- Life Insurance with Long-Term Care Rider: This route guarantees you won’t lose your premiums even if you never need long-term care. Your loved ones will also receive a death benefit to provide financial security.
- Self-Pay or Medicaid: You can earmark a sum for self-pay, or once your assets dwindle to specific levels, Medicaid will kick in to cover long-term care.
Get Coverage For What Medicare Won’t Cover at Medicare School
While Medicare is very comprehensive, understanding its limitations in dental, vision, hearing aids, and long-term care enables you to make informed decisions on supplementing these needs. If you need coverage for dental, hearing, or vision, schedule an appointment with a Medicare guide. We will help you find a plan that works for your needs and your budget. If you want to explore your long-term care options, give us a call to be connected with resources to receive coverage.
Want to learn more about what Medicare will cover? Sign up for our free, virtual Medicare workshop.