Understanding the Limitations of Medicare Coverage

Most of us expect that when we turn 65, we will enroll in Medicare and the program will then provide for our healthcare needs. And while that might be true with regard to hospitalization and medical care for most circumstances, the program actually does not cover everything that you will need. It’s important to understand the limitations of Medicare, so that you can plan and budget for uncovered services.

Vision exams and correction. Original Medicare does cover medical treatment for things like cataracts. But routine eye and exams and vision correction (glasses or contact lenses) will be your responsibility. You can self pay, enroll in a supplemental vision plan, or look for a Medicare Advantage plan that does offer vision coverage.

Dental services. Original Medicare will not pay for dental exams, cleanings, and routine procedures like filling cavities. It also does not cover dentures. However, some Advantage plans do include dental services. A supplemental plan provides another option.

Hearing aids. While Original Medicare does cover medical treatment for conditions that affect the ears, it does not cover hearing exams and hearing aids due to normal hearing loss. Recent legislation has allowed for certain types hearing aids to be sold over the counter, making them more affordable for those who self pay. Some Medicare Advantage plans do cover hearing exams and hearing aids.

Cosmetic surgery. Medicare plans won’t cover the cost of elective cosmetic surgery. However, reconstructive surgery to repair issues caused by an illness or accident will often be covered.

Podiatry. Medicare coverage for podiatry is mixed, with some services covered and some services not covered. Check your plan carefully to understand its limitations, and consider another way to pay for podiatry services in the event that you need them.

Medical care in other countries. If you plan to travel, you should know that Original Medicare and Medicare Advantage plans only cover healthcare received within the United States. A Medigap policy might be a good option for those who want to travel abroad.

Long-term nursing care. Contrary to common belief, Medicare coverage for nursing care is extremely limited. A short-term stay in a rehabilitation facility will usually be covered, subject to certain limits. But if you need to move into a long-term, residential nursing facility, you need to find another way to pay for it.

As you can see, Medicare coverage does have its limits. In some cases an Advantage plan will provide for more comprehensive needs. But you should work carefully with an experienced insurance specialist in order to understand the provisions of your plan, and make arrangements to self pay for some services.