Medicare, a federal program, provides health insurance for Americans aged 65 and older, as well as certain younger people with disabilities. It's a valuable resource, covering a broad range of health care services such as hospital stays, doctor visits, and prescription drugs. However, while Medicare does offer extensive coverage, it isn't all-inclusive. There are important gaps that beneficiaries need to be aware of. This article delves into five major services that Medicare does not typically cover.
Long-Term Care
Most people might assume that Medicare will cover long-term care, such as a nursing home or assisted living. However, this is a common misconception. Medicare Part A will cover a limited stay in a skilled nursing facility for rehabilitation, but only if it follows a hospital stay of at least three days. Anything beyond this, including custodial care (help with daily activities like bathing, dressing, eating, etc.), is not covered. For such services, individuals often have to turn to Medicaid, private long-term care insurance, or personal savings.
Dental, Vision, and Hearing Services
Routine dental care, including check-ups, cleanings, fillings, dentures, or extractions, is not covered by Medicare. Similarly, routine vision care, such as eye exams for glasses or contact lenses, is also outside its scope. Medicare also does not cover hearing aids or exams for fitting them. Some Medicare Advantage plans (Part C) offer coverage for these services, but these plans come with additional costs.
Cosmetic Surgery
Medicare does not cover cosmetic surgery unless it's needed because of another health issue. For instance, if you've had a mastectomy due to breast cancer, Medicare would cover breast reconstruction surgery. However, procedures like facelifts, tummy tucks, and liposuction are considered cosmetic and are not covered.
Prescription Drugs (without Part D)
Original Medicare (Parts A and B) does not cover most prescription drugs. To get coverage for prescription medications, beneficiaries need to enroll in a separate Part D plan or choose a Medicare Advantage plan that includes drug coverage. It's important to note that these plans come with additional premiums.
Care Outside the United States
With few exceptions, Medicare does not cover health care services received outside the U.S. This can be a hurdle for retirees who plan to travel extensively or live abroad. Some Medigap and Medicare Advantage plans offer coverage for emergency care abroad, but these come with additional costs.