7 Things Medicare Doesn’t Pay For

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Updated: June 6, 2022


7 Things Medicare Doesn’t Pay For


At a certain point in your life, you may begin to think about yourself differently. You may suddenly discover that you are no longer the “kid” at work. Wrinkles become permanent instead of only appearing on occasion. And then a little one begins to call you “Nana” or “Papa,” and you know that you are approaching the downward curve of life.

To prepare for your golden years, you must understand your financial obligation when it comes to your health. After all, it is likely that the number of doctors’ appointments will be increasing. How are you going to pay for those appointments with doctors who look young enough to be your grandkid? There are other costs associated with aging that must be factored in as well, such as Life Alert cost. 

We are going to give you a quick overview of the Medicare program, but the bulk of this article will focus on informing you about medical expenses that Medicare will not cover.


What is Medicare?


What is Medicare?

Medicare is a federal health insurance program for people who are 65 years and older and other groups who meet specific qualifications. Medicare is divided into three programs, parts A, B, and D.

Medicare Part A covers hospitalization. It also includes some skilled nursing care and home health care. Finally, it also covers hospice care as you face the end of your life.

Medicare Part B covers doctor’s visits, whether they are for sickness or preventative services. It also covers medical supplies and outpatient care.

Finally, Medicare Part D covers prescription drugs.

If you have lived on this earth for close to 60 years, you know that there’s a lot of fine print when dealing with government agencies — especially those involving health care. For that reason, instead of going into the details of what Medicare covers, we are going to tell you about some of the things that you will need to be prepared to pay for on your own or through supplementary insurance.


1. Long-Term Care

Whether you choose to age in place with the help of friends, family, and home health aides, or you choose to move to an assisted living facility or nursing home, there are costs associated with that care. Skilled care may cost thousands of dollars each month, and although Medicare covers some specialized nursing services, the rules for the services that are included are rather strict.

To help pay for long-term care, you may consider taking out an additional insurance policy. Although long-term care insurance will not cover every penny of your stay at a nursing facility, it will help offset the costs.

2. Coinsurance & Deductibles

Just because you have reached the age of 65 and have Medicare, doesn’t mean that you will no longer have financial responsibility for your health care. There are Medicare costs to be aware of.

Even though the coverage varies from year to year, you may have to pay some out of pocket expenses before Medicare begins covering for the services you receive. For example, if you find yourself facing a long medical stay, you will have to pay hundreds of dollars per day in coinsurance after 60 days in the hospital. There is also a limit to the number of days in the hospital that Medicare will cover under Part A coverage.

Part B Medicare will cover most of your doctor’s visits, tests, and x-rays, but you have to meet a deductible first. After the deductible is met, you will be required to pay coinsurance for each service you receive.

3. Dental Care

Basic Medicare does not cover the expenses of routine dentist appointments and cleanings. You are also on your own if you need x-rays, fillings, and dentures.

Keep in mind, if you currently have a Health Savings Account (HSA), you can continue to contribute funds to it until you enroll in Medicare. Even though you can’t contribute to your HSA after you enroll, you can still use the money for things like coinsurance, co-pays, deductibles, and things like tooth extractions and root canals.

4. Vision Care

Medicare does not cover your routine eye exams and the costs associated with eyeglasses and contact lenses. There may be exceptions to this rule if you have diabetes or after cataract surgery.

Again, like dental care, you can pay for your vision care using HSA funds you may have.

5. Hearing Aids

Hearing aids can be expensive, and Medicare doesn’t cover the cost. Some discount programs may be available that will include lower-cost hearing aids.

6. Healthcare outside of the U.S.

If you plan to travel extensively during retirement, make sure you understand what your medical plan will cover. Medicaid has a restrictive policy for paying for treatment outside the U.S. There are other avenues available to cover these costs, including travel insurance policies.

Keep in mind that even if you are able to travel back to the U.S. to receive treatment, you may have to pay for emergency travel to leave your cruise ship or African safari. Of course, medical evacuation costs can be astronomical.

7. Prescription Drugs

You may have noticed earlier that Medicare Part D covers prescription drugs. While this is true, there is an additional cost involved when signing up for a Medicare part D plan.


Final Thoughts

Does the list of what Medicare does not cover scare you? You are not alone. No one likes the idea of running out of money during retirement because you have to pay for healthcare costs.

Some people facing retirement purchase Medigap Insurance policies or Medicare Advantage plans. Such additional coverage is sold by private insurance companies and will help pay for the services that Medicare doesn’t cover. There are ten standardized versions of insurance that fill in the gaps of your Medicare coverage. Of course, they vary on cost and coverage options.

These policies should be purchased during the Medigap Open Enrollment period which is six months after turning age 65 and signing up for Medicare Part B. If you decide wait to sign up for this  additional coverage, you may be rejected for current health conditions or pay higher premiums. See When can I buy Medigap? from medicare.gov, for more information.

You can change the basics of your Medicare services during open enrollment each fall. This means that even if you initially did not sign up for Medicare Part D, you can add it later in retirement if your prescription drug costs do not seem to be covered as much as you expected by another plan.

Navigating medical costs during retirement can be tricky, but each medical facility should have someone on staff who understands the intricacies of the Medicare system. Seek the help of these individuals or visit the Medicare.gov website to find the answers to specific questions.


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