Medicare is a lifeline for many seniors, providing essential health insurance backed by the federal government. However, it doesn’t cover everything, leaving some unexpected out-of-pocket expenses for beneficiaries.
Understanding these gaps is key to effective financial planning for retirement. Following are seven essential expenses that Medicare typically won’t cover.
1. Long-Term Care Services
Long-term care, such as assistance with daily activities like dressing or bathing, is generally not covered by Medicare. This includes care received in nursing homes, assisted living facilities, or in-home custodial services.
According to a Genworth Cost of Care Survey, the national median monthly cost for a private room in a nursing home is $9,733. Planning ahead with long-term care insurance or savings is essential for those who may need these services.
2. Routine Vision Care
Original Medicare does not cover routine eye exams for glasses or contact lenses. Beneficiaries are responsible for the full cost of routine vision care, including exams and eyewear, unless they have a Medicare Advantage plan that offers vision benefits.
However, Original Medicare does cover eye exams related to specific conditions like glaucoma or diabetic retinopathy. For more information on Medicare’s vision coverage, refer to the official Medicare website.
3. Dental Care
Routine dental services, such as cleanings, fillings, and dentures, are not covered by Original Medicare.
While some Medicare Advantage plans include limited dental coverage, beneficiaries on Original Medicare are responsible for 100% of dental care costs.
This gap can be significant, especially for seniors who require extensive dental work. Check out more details on what Medicare does and doesn’t cover at Medicare Interactive.
4. Hearing Aids and Exams
Hearing aids and the exams needed to fit them are not covered by Original Medicare, leaving beneficiaries to pay out-of-pocket for these often-expensive devices. Diagnostic hearing exams to identify medical conditions may be partially covered, with the patient responsible for copays and deductibles.
For seniors who rely on hearing aids, considering supplemental insurance or saving for these expenses is wise. Some Medicare Advantage plans may offer coverage for hearing aids, so comparing plan options is a good strategy.
5. Chiropractic Care Beyond Manual Spinal Manipulation
Medicare Part B covers manual manipulation of the spine to correct subluxation when ordered by a doctor, but other chiropractic services, such as diagnostic tests or maintenance care, are not included.
This means that routine visits to a chiropractor for preventive or general wellness adjustments will come out of pocket. Details on Medicare’s chiropractic coverage can be found at Medicare.gov.
6. Premiums for Certain Parts of Medicare
While Medicare provides subsidized coverage, it’s not without costs. For example, beneficiaries must pay monthly premiums for Medicare Part B, which covers outpatient services.
n 2024, the standard monthly premium for Part B starts at $174.70, with higher amounts for those with higher incomes. Medicare Advantage plans may also come with additional premiums on top of the Part B cost.
Learn more about Part B premiums and costs on the Medicare.gov page.
7. Care Received Outside the U.S.
If retirement plans include international travel, know that Original Medicare offers very limited coverage for care outside the U.S. or its territories. This applies to medical treatment as well as prescription medications purchased abroad.
While some Medicare Advantage plans may provide coverage for emergency services while traveling, you might want to consider purchasing supplemental travel insurance for full protection. For more on what Medicare covers, visit the Medicare.gov site.
Prepare for the Unexpected
Understanding Medicare’s limitations can help seniors plan for potential out-of-pocket costs and make informed decisions about supplemental insurance or additional savings.
Whether considering long-term care insurance, exploring Medicare Advantage plans for additional coverage, or budgeting for routine health expenses, being proactive can lead to a more financially secure and comfortable retirement.