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What Medicare Covers Today-It’s Probably Not What You Think!

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Medicare was designed to take care of your major needs as you age. However, it doesn’t pay for everything, and it’s important to know what Medicare will and will not cover so you can plan wisely for your future financial needs.

Plan A of Medicare covers your expenses related to hospital and emergency care, skilled nursing, hospice care and home healthcare related to skilled nursing and hospice needs. Part B pays for 80% of most of your medically necessary visits to your doctor as well as preventative services to keep you from becoming ill.

Take this Self-Quiz: What does Medicare refuse to cover?

The table below gives examples of items and services that you might need in the future. Look at each item and make an educated guess as to whether Medicare covers this particular health aid or service to see what you already know. The answers are included in the text below.

What Medicare Covers Today-It’s Probably Not What You Think

Medicare does not cover long-term care.

If you require assistance with daily living skills such as meal preparation, bathing, dressing, or help with going to the bathroom and you aren’t under skilled nursing care or homebound, then Medicare does not pay for these costs. Medicare will not cover the cost of an assisted living facility or custodial care even if your doctor advises that it’s time for your or a loved one to have this type of care. If you choose to hire individual caregivers to come to your home to provide these services at an hourly rate or daily rate, Medicare does not pay any of these costs.

A Genworth survey showed that the average cost for an assisted living facility was $3,750 in 2017.  Many facilities have an a la carte service with additional charges for managing medicines, hygiene care needs and medical supplies. A home health aide might charge $4,099 per month. These fees are expected to climb higher as more Baby Boomers with a longer life expectancy enter this stage of their lives.

Medicare does not cover routine dental care, vision, hearing or foot care.

Dental Care

Medicare does not cover routine visits to your dentist or treatments such as routine fillings, root canals or crowns. Dentures are not covered either.

Vision Care

Medicare provides a simple vision test using an eye chart as part of your yearly wellness exam. Office visits to vision specialists and eyeglasses/contact lenses are not covered.

Hearing Care

Medicare Part B (Medical Insurance) covers diagnostic hearing and balance exams if your doctor or other health care provider orders them to see if you need medical treatment. Medicare doesn’t cover routine hearing exams, hearing aids, or exams for fitting hearing aids.

Foot Care

Cutting or removal of corns and calluses, trimming and cutting of nails and cleaning and soaking the feet are not covered by Medicare. Podiatrist services for medically necessary treatment of foot injuries or diseases (like hammer toes, bunion deformities, and heel spurs) are covered under Medicare Part B.

Medicare does not cover alternative medicine.

Chiropractic services and acupuncture are excluded by Medicare. One exception is the correction of a subluxation of the spine.

Medicare does not cover a private hospital room unless medically necessary.

Medicare Part A (Hospital Insurance) covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies You pay for private-duty nursing, a television, or a phone in your room.

Medicare does not cover cosmetic surgery.

Medicare doesn’t cover cosmetic surgery unless it’s needed for an accidental injury or to improve the function of a malformed body part. Medicare does cover breast prostheses for breast reconstruction if you had a mastectomy because of breast cancer.

Self-Quiz Results

None of the items in the table above are covered by Medicare (unless for the exceptions stated). If you wish to learn more about what Medicare will and will not cover, go to Medicare’s website and type in the topic you wish to research.

Kae Hammond
Senior Care Specialist
HighTower | Blanke Schein Wealth Management

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