You’ll need to plan to pay for some common medical expenses
Published by: AARP
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.
1. Opticians and eye exams
While original Medicare covers ophthalmologic 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.
2. Hearing aids
Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids.
3. 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.
4. Overseas care
Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs incurred outside the U.S.
5. 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.
6. 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.
7. 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 chiropractic service: 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.
8. 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 covers chiropractic care in certain limited circumstances and 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.
9. 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 yearly for a semi-private room and more than $100,000 for a private room. Costs vary based on where you live and what facility you choose.)
10. 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 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.