When people turn 65 and become eligible for Medicare, they are sometimes surprised to learn that Medicare doesn’t cover all of their healthcare expenses and services.
On average, Medicare covers around 80% of your inpatient and outpatient services. There are also some items which are not covered by Medicare at all.
Learning what Medicare covers ahead of time will certainly help you not to experience any unwelcome surprises. doesn’t cover will help you be better prepared for your enrollment ahead of time.
Items That Medicare Doesn’t Cover
When Medicare was first rolled out in the 1960’s, it was designed to cover hospital services and medical services. There are several things that fall outside of these that are not covered by Medicare at all.
These include routine dental, vision, hearing and foot care. Original Medicare also does not cover cosmetic surgery, most medical care in foreign countries, or long-term care like nursing home or assisted living facility care.
Medicare also did not cover any outpatient prescription drugs for many years. However, in 2006, Congress rolled out a voluntary program to help with outpatient medication expenses called Medicare Part D.
For many years, Medicare didn’t cover preventive care, but in 2010 this was changed and now Medicare offers an annual physical as well as a number of other preventive care procedures.
Fortunately, there are also many individual insurance policies on the private marketplace to help with some of the other items, such as dental, vision and hearing insurance or long-term care insurance.
Covering the Gaps
We mentioned that Medicare covers only about 80% of your medical expenses. You pay the rest in the form of deductibles, coinsurance, and copays.
You can purchase insurance coverage that helps you to pay these expenses when they arise. There are two primary types of additional coverage that you can choose.
You can choose to enroll in a Medigap plan or you can opt to get your Original Medicare benefits through a private insurance program instead, called a Medicare Advantage plan.
Medigap plans are sometimes called Medicare supplements. These plans pay after Medicare first pays its share. The plans help to cover the deductibles, copays, and coinsuranceon your behalf. There are ten standardized plans to choose from in most states, and there are several plan options provide a foreign travel emergency benefit up to $50,000 as well.
You can use your Medigap plan at any Medicare provider nationwide and you never need to get a referral.
Medicare Advantage plans are also called Medicare Part C plans. These private insurance plans typically involve treating with the plan’s network of providers. Typical networks include HMO-style networks where you must choose a primary care doctor or PPO networks where you can see any doctor in the network and even treat outside the network at additional costs.
You will pay copays for various medical services as you go along, and these expectations will be outlined in the plan’s Evidence of Coverage booklet.
Part C Medicare Advantage plans can also build in some extras that Original Medicare doesn’t usually cover, such asdental care, vision exams, and eyeglasses, hearing aids, and even gym memberships. Each plan must cover all of the same medical services as Original Medicare, but how you pay for your share of these services is different. Approximately 30% of Medicare beneficiaries enroll in a Medicare Advantage plan.
Prepare Ahead of Time
Though Medicare isn’t free, you can work with a financial planner or Medicare insurance broker to estimate your costs for Medicare ahead of time. This will help you avoid any unwelcome financial surprises and also help you to fully understand how your coverage will operate.
Danielle Roberts is the co-founder at Boomer Benefits, where she and her team help new Medicare beneficiaries to learn about their coverage and benefits. You can visit her website to learn more about your eligibility for Medicare.
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