Know your Benefits: Here is what Medicare Does Not Cover

Social Security card and Medicare enrollment form

Looking forward to that milestone age of 65? You’ll be covered by Lyndon B. Johnson’s Medicare bill. Hailed by liberals as LBJ’s signature achievement, the bill set up Medicare, a health insurance program for the elderly. It also extended insurance to the poor in the form of Medicaid.

Medicare is not free. You pay premiums out of your monthly Social Security Check, and those premiums keep going up. What Medicare covers depends on what you sign up for. Essentially Medicare coverage includes:

  • Part A — Hospital, nursing facility, hospice, and home health care
  • Part B — Medically necessary and preventative services
  • Part C — Medicare Advantage plans offered by private insurers approved by the Medicare program
  • Part D — Drug coverage

You can log on to Medicare.gov for a rundown of benefits. It all becomes confusing and complicated when Medicare combines with other insurance. Essentially, when your physician sends a bill, Medicare, as the primary payer, pays what the system allows. The rest goes to a secondary payer.

The reasons for all that confusion and paperwork, especially when there is a dispute between your doctor and the insurers is that Medicare not only disallows much of what hospitals and physicians claim, but also Medicare does not cover the following common expenses:

–Dental care—Some Part Medicare Part C plans will cover some routine dental services, depending on the specifics, but the original Medicare plan covers no dental care or routine procedures, unless the patient needs restorative treatment during hospital care. The bottom line: Unless you have your own dental care plan, you’ll need to plan to pay 100% of your dental expenses during retirement.

–Eye care—Again, original Medicare does not cover eye exams, eye glasses, or contact lenses. However, visits to an ophthalmologist for glaucoma treatment and macular degeneration treatment are covered. If you suffer from diabetes, your doctor can bill Medicare for examinations. Likewise, artificial eyes ordered by your doctor are covered, but you’ll have to pay 20% of the expenses after a deductible.

–Hearing aids—Medicare doesn’t cover hearing aids, which can cost thousands. However, the audiologist who fits the hearing device can bill Medicare for 80% for the cost of diagnostic hearing exams.

–Long-term care—That would be medical and nonmedical services for patients who can’t cope with basic daily tasks like dressing or bathing themselves. Those costs, typically ranging up to $9,000 per month at private nursing homes, are not covered by Medicare. If you expect to experience those expenses, you’ll need to look into long-term care insurance.

So, it’s hard to miss the irony here. Medicare was designed to care for the elderly. Older folks typically experience dental, sight, and hearing problems, and need for long-term care, which are specifically not covered.

Then there are the Medicare insurance premiums. Medicare Part B premiums for people earning over $12,000 a year in 2021, can look forward to a 2.7% erosion in their Social Security benefits. Plan to see $148.50 deducted from your monthly check. You also may know that most Social Security recipients pay income taxes on 85% of their Social Security benefits.


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