The U.S. federally funded program, Medicare, is a significant source of health insurance for people over 65 and certain disabled individuals. While it provides broad coverage for various medical services, there are several areas that Medicare does not cover. Understanding these gaps in coverage is crucial for anyone relying on this program for their health care needs. This article explores four key benefits that are not included in Medicare.
Long-term Care
Most people assume that Medicare will cover long-term care costs, particularly for seniors. Unfortunately, this is a misconception. Medicare does not cover long-term custodial care, which involves assistance with daily living activities such as bathing, dressing, eating, and using the bathroom. While Medicare does cover medically necessary skilled nursing facility or home health care, it does not include custodial care. This gap in coverage can leave beneficiaries with significant out-of-pocket costs if they require long-term care services.
Dental, Vision, and Hearing Services
Routine dental, vision, and hearing services are vital for maintaining overall health, especially as individuals age. Regrettably, Medicare does not cover regular dental check-ups, eyeglasses, or hearing aids. Some Medigap and Medicare Advantage plans offer coverage for these services, but they often come with additional premiums. Consequently, beneficiaries may have to consider standalone policies or pay out-of-pocket for these services.
Prescription Drugs
Prescription drug coverage is another significant gap in Original Medicare (Part A and B). While Medicare Part B may cover certain drugs like injections you get in a doctor's office, most prescriptions you take at home are not included. To get coverage, beneficiaries must enroll in a separate Part D plan or a Medicare Advantage Plan that includes drug coverage. These plans come with additional costs, including premiums, deductibles, and co-pays.
Travel Abroad
For those who love to travel, it's important to note that Medicare coverage is generally restricted to the U.S. and its territories. This means if a beneficiary needs medical care while traveling abroad, Medicare will likely not cover it. There are a few exceptions, including emergencies in Canada and Mexico, but overall, international medical coverage is limited. Beneficiaries who travel frequently may need to consider supplemental travel insurance.