Medicare Doesn't Cover Everything

What’s Not Covered by Medicare?

Medicare provides health insurance for retirees, but it doesn’t cover everything. In fact, there’s a lot that Medicare does not cover, and many of these are health care costs that can consume a nest egg. Here are the top five healthcare costs that should be part of your retirement preparations:

Medicare and Long Term Care Costs

Long Term Care is one of the biggest budget busters for retirees. Long term care can easily cost tens of thousands of dollars a month. Medicare does offer some skilled nursing care coverage, but it’s very limited. If you are eligible, in terms of age, health and finances, buy a long-term care insurance. Sometimes a long-term health insurance policy is folded into a life insurance policy. Talk to your insurance broker—this is something you need, as much as an estate plan.

Alternative or Chiropractic Care

If your healthcare includes alternative or chiropractic care, Medicare is not yet fully evolved to pay for these services. The monthly massage that you know keeps headaches or crippling joint pain at bay is not covered, regardless of how effective it is for your well-being. There are some Medigap or Medicare Advantage plans that do cover specific kinds of alternative therapies, so do your research.

Dental and Oral Health

Medicare does not connect your healthy smile with your overall health. Despite studies that clearly demonstrate the connections between good oral health and overall health, especially cardiovascular health, Medicare is not paying for your dental treatment, unless they are “medically necessary” for you before your physician will allow you to undergo covered procedures.

But in most cases, you have to pay for your own dental care. And if you’ve ever needed a crown or root canal work, you know these procedures can cost several thousand dollars. Best to set aside some assets for dental work.

Glasses and Vision Care

The same goes for vision care. The cost of an eye exam, glasses and contact lenses must be paid by you. There are more options today than there were ten years ago (i.e., online, or big box prescription glasses and contact lenses) but it’s still an expense that you need to cover yourself.

Hearing Aids

Hearing aids are the bane of many retiree’s financial life. They are extremely expensive, and Medicare doesn’t cover the audiology exam that is needed before you can be fitted for them or the devices themselves, some of which can cost as much as $10,000. A federal law was passed in 2017 that directed the U.S. Food and Drug Administration to ease the financial barriers to purchasing a hearing aid, but the self-fitted, less expensive devices don’t work for everyone.

Medicare Advantage Free Consultation

Does Medicare Advantage Make Your Medical Coverage Better or Worse?

Some of the smartest people we know find enrolling in Medicare confusing and overwhelming. Despite the warm and fuzzy commercials from insurance companies, Medicare Advantage plans are tricky to figure out. And sometimes, Medicare Advantage can be more expensive than traditional Medicare.

You want to go into the Medicare enrollment process with information to prevent yourself from making expensive mistakes. This is why we are offering area residents a free Medicare consultation—we do not want to see seniors spending more than they need by selecting the wrong plan.

Medicare Advantage plans can have higher copays and other costs. And if you switch back to traditional Medicare, you may not qualify for the supplemental policies, or the premiums may take a huge jump.

The first part of understanding the process is understanding how these pieces work:

There are three parts to Medicare coverage:

  • Part A covers hospitalization and is premium free.
  • Part B covers outpatient care, including doctor visits. The monthly premium for Part B is based on your income two years before this year. It starts at $144.60 and is based on income tops out at $491.60.
  • Part D covers prescription drugs.

Most doctors still accept traditional Medicare, so you probably can continue with your caregivers. The same may not be true for Medicare Advantage.

Part D is for prescription drug coverage. That is provided by private insurers, and it gets complicated. In Nassau County, there are twenty-seven Part D plans available. The drugs covered by each plan are different, as are the copays and deductibles. Premiums can range from $30 per month to over $150.

Traditional Medicare also has deductibles, copays, and co-insurance. To cover the cost of these “gaps,” private health insurance companies offer supplemental plans known as Medigap. These plans are lettered from A through N to make comparisons easier. For example, every insurance companies A plan must provide the same basic benefits. One good thing: If you apply for a Medigap policy when you are first eligible for Medicare, the insurance company must accept you and cannot charge for preexisting conditions.

Medicare Part C is also known as Medicare Advantage. It is a program where your Medicare premiums are given to private insurance companies to provide the services. Medicare Advantage does not add to other parts of Medicare, but it replaces them. If you enroll in a Medicare Advantage plan, your insurance company must provide you with the benefits of Medicare Parts A and B.  Most Medicare Advantage plans include Part D –drug coverage. Most plans (but not all) cover other expenses that Medicare does not, like hearing, vision, and dental care. However, you will have a copay for most services.

While some Medicare Advantage enrollees in 2020 did not pay an additional premium for coverage over their regular Part B. premiums, these plans are usually limited in the number of health care providers and can have significant copays.

So, should you consider Medicare Advantage?

Medicare Advantage plans are like employer-provided health insurance. You must choose providers in the network, which may be limited especially if the plan is an HMO (health maintenance organization) or less limited if it is a PPO (preferred provider organization). Certain kinds of care may need approvals, and specialists may need referrals. Go out of network, and your costs may not be covered, or the cost may not be applied to your out-of-pocket limits. And Medicare Advantage providers can stop offering coverage in your area at the end of any year, leaving you out in the cold

Just because your provider was in your network one year does not mean they will be in your network the following year. And the plans are regional, so if you move out of the area or spend a lot of time on another state, you may not be covered.

On Long Island, there are 30 Medicare Advantage options, and networks, coverage, deductibles, copays, and co-insurance are very different in each plan. But if you need a lot of medical care, Medicare Advantage costs less upfront and possibly more overall.

Medigap plans have higher upfront costs but cover most if not all expenses if you need care.

Here is another thing to remember: To switch from one Medicare Advantage program to another, you may do so during open enrollment periods. However, to switch from Medicare Advantage to traditional Medicare, you may not have access to a Medigap policy. The insurance company may charge you more, exclude preexisting conditions or deny coverage completely.

Confused? Call our office at 516-307-1236 for a free consultation about your Medicare coverage. We are not an insurance agency, so we have no bias for or against any insurance plan. We do want to help seniors make the right choice.


Reference: Yahoo Finance (Sept 17, 2020) Are Medicare Advantage Plans Worth the Risk?”