2019-04-12 / Society

Seven top services Medicare doesn’t cover

Contributed by Insurance Management Group

Every day, 10,000 Americans turn 65 and begin Medicare coverage. At last, they have health care coverage for life. But what many don’t realize is the array of services they’ll still have to pay for on their own.

Original Medicare consists of two parts, A and B. Part A covers hospital stays, skilled nursing, hospice, and some home health services. However, it does come with a $1,340 deductible per benefit period, and benefits are capped.

Part B covers doctor visits, outpatient services (think flu shot) and medical equipment. Singles who bring in less than $85,000 (double that for married couples filing jointly) a year pay $134 a month with a $183 deductible. Typically, you pay 20 percent of services after the deductible is met

Prescription drug coverage is provided through Part D, or you can opt for a Medicare Advantage Plan (also known as Part C) through an insurance company that will cover Part A, Part B and Part D.

Despite all the things Medicare covers, it is not a head-to-toe plan. The average couple who retires at age 65 will wind up spending another $280,000 on health care throughout the rest of their lives. Here are the gaps you’ll need to watch out for:

Vision

Medicare will cover glaucoma, cataracts and macular degeneration. But for the routine vision checks most of us require, you’ll be paying out of your own pocket. Ditto for eyeglasses and contacts. Initial exams can cost $200, with repeat exams averaging $125. Glasses from the neighborhood eyewear store can be an eye-popping $200-$400.

Cover vision costs. For help with the cost of eye examinations, check around for the best deal. Some opticians run specials, such as a free exam with an eyewear purchase. Costco and Sam’s Club offer inexpensive exams that may justify the price of a membership. Check your local Walmart for the cost of an eye exam, too.

To order online, you’ll need to have not only your prescription for lenses but also eye size, bridge size and temple length. If you have a pair of glasses you already wear, you can likely find the numbers printed on the frame. Or, use the handy guide at Frames Direct to get the measurements.

Hearing

Half of seniors above age 75 have disabling hearing loss, but you’ll have to hand over greenbacks for hearing aids since Medicare doesn’t cover them. And hearing loss is not something you want to let go, because your brain loses its ability to interpret the signals sent by your ears as you lose your hearing. Wait too long, and hearing aids won’t help.

The average price of just one hearing aid runs about $2,300, or up to $20,000 for specialized models. Ouch! The FDA is in the process of evaluating and rating personal sound devices, which sell for much less.

Dental

The average cost per senior for annual dental care is a whopping $685, and specialty visits will tack on more. Nearly a quarter of seniors ages 65 to 74 have severe dental disease, quite likely because dental care requires paying out of pocket. Medicare doesn’t cover preventive cleanings and x-rays, nor fillings or root canals. If you need dentures, you’ll have to cover them, and ditto for oral surgery to combat gum disease.

Medicare does cover treatments that are essential before someone can undergo another procedure that is covered. For example, extracting a decaying tooth prior to having open heart surgery. Yes, that’s it, so keep your toothbrush and floss handy.

If you have a Medicare Advantage plan, you may have some coverage for routine visits to an in-network dentist. Advantage plans are all different, so contact your insurer to find out if you have a dental plan. Additionally, some Medicare/Medicaid dual-eligible plans offer limited coverage.

Cover dental costs. For cleanings, you can go to a new dentist and take advantage of advertised special deals for first visits. The latest research shows you really only have to visit once a year to get the same benefits provided by recommended twice-yearly cleanings.

Long-term care

Custodial care (also known as “assisted living”), the routine care that usually pushes many older adults into nursing homes, is not covered under Medicare. This is a big one, since a 2017 Genworth Cost of Care Study found the median cost of a private room in a nursing home is about $97,500 and the same room in an assisted-living facility costs $45,500. With average retirement income for all Americans over 65 averaging $31,740 per year, you can see the math doesn’t add up.

Home care, (like RetireEASE Senior Services that provides companionship, light housekeeping, transportation and personal care, etc.) for seniors who are aging in place is also NOT a covered benefit. Many seniors believe that Medicare supplements, Advantage plans or TRICARE For Life will pay for these non-medical expenses.

Not everyone is going to need long-term care, but what if you do? There’s no way of telling ahead of time if you’ll get lucky, or break a hip and end up in senior living. You can buy a longterm care insurance policy that will help cover costs. Premiums average $3,560 annually for a couple in their 60s to get a policy with payouts of $150 daily, which is less than the $220 daily average expense. One caveat is that this coverage is usually obtained well before you need it, while you’re still insurable.

Check if you qualify for VA benefits as a former military personnel or a family member of one. Finally, you may need to spend down your benefits to qualify for Medicaid, which covers you in certain facilities. You may be wise to consult an attorney regarding how to preserve wealth; doing this as early in the process as possible may give you more options.

Medical care outside the U.S.

You’re on that dream vacation in Australia, and you trip over the wastebasket in your hotel room. Or a shark bites your arm. Or that salad you ate yesterday is causing severe distress. Doesn’t matter; Medicare doesn’t cover you abroad. Heart attack? You’re not covered. Need to be airlifted from your rafting expedition? Not covered.

Cover care overseas. A Medicare Advantage plan often covers emergencies worldwide, but may not pick up the tab for routine care. If you have a basic Medicare plan (Parts A and B), you can purchase an optional Medigap policy for travel. A 65-year-old male would part with between $159 and $236 for a plan that would handle up to $50,000 while you’re outside the U.S., or add on an additional standalone plan for more coverage.

Observation

Say you tweak your knee and go to the hospital, which admits you for observation for a few days. Afterwards, you need rehab for your injury. Rehabilitation involves skilled nursing care, which is covered under Part A if you’ve been admitted to the hospital for at least three days. But if they only admitted you for observation, you’re out of luck and rehab will come out of your wallet.

Cover rehabilitation. Always ask the hospital to admit you. In some cases, they may refuse. Be aware that going to the hospital and even spending the night does not always mean you’ve been officially admitted. For about $35 (and up) per month, you can get a hospital indemnity plan that covers up to $600 per day for a certain number of days.

Alternative treatment

If you count on massage, acupuncture or chiropractic treatments to keep you in optimum health, don’t expect Medicare to foot the bill. Medicare doesn’t reimburse for your Chinese herbs, either. Before paying out of pocket, always check with your insurer to see if a service is covered.

Massage schools are a great way to get cheaper treatment. Many offer student massages once a week. Ask your chiropractor or acupuncturist if she has a reduced cash price. Lastly, invest in a foam roller and see if you can go longer between sessions, or replace a session with a yoga or Pilates class covered by Silver Sneakers.

In sum, the most important thing you can do before you schedule a procedure is check with Medicare, or your Medicare Advantage insurer, to see if a procedure is covered. Secondly, check around for deals before you buy services or aids. Finally, make sure the hospital (which should be in-network if that’s a requirement) is coding you as “admitted” and not “observation.” It’s a good idea to have a friend or family member aware of your needs so you have an advocate to accompany you.

*Information in this article was provided by the Society of Certified Senior Advisors and Steve Parrott, CSA. Steve is the owner of RetireEASE Senior Services and Licensed insurance agent for Life, Health and Medicare Supplemental policies. If you have questions or want more information, you can contact Steve at Steve@retireease.com.

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