Most medically necessary treatment is covered by Medicare Part A and B, but do you know what ISN’T covered? How about eye exams or dental care? Does Medicare cover diabetic supplies? Surely Medicare pays for your nursing home and home health care. Hospice care?
Medicare supplement plans will pay for medical care that is not covered by Medicare.
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What isn’t covered by Medicare?
The people at Forbes posed this question and responded with a Pre-retiree Guide to Medicare. Some things may surprise you, some not.
Many health expenses covered by private health insurance policies are excluded from Medicare Part A and Part B and these uncovered expenses can easily amount to thousands of dollars a year. Among the uncovered items: dentures, hearing exams and aids, eye exams related to corrective lenses, long-term care and custodial care.
Medicare coverage of any kind for nursing care is very limited and largely based on medical necessity. If you’re in a care facility, Medicare covers so-called “skilled care” — what’s performed by a medical professional. Custodial care (such as bathing, feeding and helping patients in and out of bed) is only covered while you also need skilled care.
If you have been covered by an employer group health plan, you may not have realized that some routine items, such as dental and vision, were part of a separate health insurance plan and not part of your regular health coverage.
While routine dental and vision care isn’t covered by Medicare, you probably don’t need these plans after you retire. Georgia Medicare Plans has found that most dental and vision plans are mostly trading dollars but these plans from Humana do deliver value.
If you think you may need help paying your nursing home bills or charges from home health care, you should consider specialized policies designed for those purposes. You may find this publication from DCH Georgia to be helpful.
Georgia Long Term Care Partnership
What’s more, custodial and skilled care are only covered for a limited time. Medicare pays all costs for the first 20 days after a qualifying medical event, but charges $152 in coinsurance for days 21 to 100, and nothing after that.
In case you are wondering, a qualifying event is a hospital inpatient admission for 3 days or longer followed by discharge to an extended care facility or approved rehab center.
Vision and Dental care
Most routine vision and dental care isn’t covered by Medicare.
If you have an eye condition, such as glaucoma or cataracts, a portion of your eye exam may be covered. A normal refractive vision test is not a Medicare covered expense.
Routine dental visits, including X-rays and cleaning are not covered by Medicare. Oral surgery necessitated by accident or illness may be a covered item by your Medicare plan.
Some Medicare Advantage plans include nominal benefits for vision and dental but the trade-off (provider networks, higher overall cost) may not be worth the price of their “free” vision and dental offering.
Low cost eye exams at places like Costco may work for you. I have been using the optometrist at Costco in Dunwoody for years and have been pleased with the cost and professional services. Their selection of eyeglass frames are a bit limited but the price is right and the new digital lenses are impressive. My most recent pair were a “retro” look (but wife approved) and much more stylish than those worn by the guy on the left. The price was less than $200 for progressive lenses including the coating.
If you have special eye conditions like my wife does, you may need a more comprehensive exam that is covered by Medicare. Her ophthalmologist participates in Medicare and bills them for the refractive portion of the exam …………. and Medicare denies it, but they do pay for the rest of his charges.
You are probably paying at least $450 more than you should for your Medicare supplement plan
If you are diabetic you probably get solicitations from companies offering “free” diabetic supplies. Some insurance agents will also peddle a plan (for a nominal monthly fee) that will pay for needles, test strips, etc.
Medicare Part B covers many routine diabetic supplies. If you only have original Medicare you are responsible for your Part B deductible ($147 in 2014) plus the 20% coinsurance of the Medicare approved amount. Your Medigap plan will pay some or all of this cost depending on the plan you have.
We recommend Medicare supplement plan G or N for most of our clients. All too often the price of Medigap plan F is exorbitant. Most Medicare beneficiaries can save $450 or more by switching to plan F with a different carrier or save upwards of $1000 by changing plans and carriers.
For more information on what is and isn’t covered by Medicare, check out this guide from CMS Medicare’s Coverage of Diabetic Supplies and Services
Even more information on what isn’t covered by Medicare
Do you still have questions about what isn’t covered by Medicare.
This 18 page guide from the Medicare Learning Network provides an (almost) complete list of what isn’t covered by Medicare.
Still have questions? Call or email. We are here to help.
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