Approximately 56 million Americans rely on Medicare to help cover the cost of their doctor visits, hospital stays and prescription drugs. But like most forms of health insurance, the program doesn’t cover everything. Services that Medicare won’t help pay for are often a surprise and can leave people with high medical bills.
Here are six services Medicare doesn’t fully cover.
Long-term care in nursing homes
“People just assume that if you have Medicare, you’ll be covered,” says Keith Lind, senior advisor for strategic policy at AARP’s Public Policy Institute.
In fact, Lind says her research shows that about half of all Medicare costs are Paid by beneficiaries out of their own pocket – and a large part is for long-term care. Medicare will pay for some short-term nursing home care, but only up to 100 days after a three-day hospital stay.
But beware: A common practice is to hospitalize patients for several nights in what is called an observation unit, which is considered outpatient care. Unless you are admitted as an inpatient, you will not qualify for necessary nursing home care after your hospital stay.
“The catch for those who don’t know is that you have to stay in the hospital for three days to go to a skilled nursing facility,” says Lind. “People on watch are surprised they’re not covered.”
Once admitted to the hospital, it is important to confirm directly with your health care team that you are being cared for as an inpatient, rather than under observation.
Traditional Medicare does not cover the cost of routine dental care, including dental cleanings, oral exams, fillings, and extractions. Glasses and contact lenses are also not covered.
However, Medicare will help pay for some services as long as they are considered medically necessary. For example, cataract surgery and one pair of eyeglasses after the procedure are covered, although you must pay 20 percent of the cost, including the Part B deductible.
And, according to David A. Lipschutz, senior policy attorney at the Center for Medicare Advocacy, there are limited criteria that allow coverage for dental care in extreme cases. A serious infection in the mouth or jaw disorder that requires hospitalization, for example due to a cancer diagnosisYou may qualify for Medicare coverage.
Many Medicare Advantage plans, which are Medicare policies run by private insurers, may offer benefits to help cover the cost of routine dental and vision care.
But Lipschutz cautions that these added benefits, while nice to have, tend to be fairly limited. For that reason, be sure to consider your broader health care needs and consider all costs before choosing Medicare Advantage over traditional Medicare.
With traditional Medicare, you can get coverage for treatment if you’re hospitalized or need to see a doctor while you’re away from home within the US. Full coverage. If your plan is a preferred provider organization, or PPO, you can get help from your insurer to pay for services outside your provider network, albeit at a lower rate. However, if your plan is an HMO, it may pay the entire bill, since these policies generally don’t pay for care provided by out-of-network health care providers.
When it comes to foreign travel, Medicare rarely covers the cost of medical services, except in special circumstances in Canada or for care provided on a cruise ship within six hours of a US port.
Many Medigap plans, supplemental insurance that helps cover the cost of care not covered by Medicare, will pay 80 percent of billed charges for emergency care that is deemed medically necessary and provided within the first two months of a travel outside the US You must first meet a $250 annual deductible. There is also a lifetime limit of $50,000 for emergency care when traveling abroad.
“Some Medicare Advantage plans do provide some coverage abroad, but you have to look specifically for it,” says Lind.
And sometimes Medicare Advantage plans offer worldwide coverage for emergencies, but not all plans offer the same extra services or define emergencies the same way.
Medicare will cover the cost of diagnostic hearing exams as long as they are ordered by your doctor to determine if medical treatment is needed. The program will also pay for cochlear implants to repair damage to the inner ear.
But Medicare doesn’t cover routine hearing exams, hearing aids, or fitting exams. earphoneswhich can be quite expensive when you pay for them out of pocket.
“Hospitalization is covered during the most acute states when medical complications are most likely,” says Lind.
The five-day limit for inpatient care for alcoholism and drug addiction may be extended based on the patient’s condition. Generally, 16 to 19 days of rehabilitation services are covered.
But as more people seek help as a result of an opioid addiction epidemic that has devastated many communities across the country, in most cases Medicare does not cover the cost of methadone, a drug commonly used to treat opioid dependence.
“Medicare will not cover methadone for opiate addiction, only for certain pain treatments,” says Lipschutz.
Alternative Medicine or Cosmetics
Alternative treatments, like acupuncture or chiropractic, are not usually covered by Medicare. Chiropractic care is covered only in cases where a licensed chiropractor manually manipulates the spine to correct a condition that causes one or more of the bones in the spine to become dislocated.