You may be surprised to find that health care budgeting is still necessary once you’re on Medicare, especially for those on limited incomes.
It is important to educate yourself on what is and is not paid for by Medicare so that you are not caught off guard by medical bills. Here are the things Medicare does not cover.
What health insurance does not cover
Examples of items and services that fall into this category include excessive diagnostic therapies or procedures, or examinations and treatments for which the patient has no symptoms or diagnosis.
Casey Schwarz, senior counsel, education and federal policy at MedicareRights.org, says people who are eligible for Medicare but currently covered by an employer health plan need to think of their loved ones, as well as themselves.
“Oftentimes, employer coverage is family coverage, which means it covers you, your spouse, and your dependents. Medicare is coverage just for you. So for some people It makes sense to keep their workplace plan even if Medicare is going to be the primary payer because they want to keep coverage for their spouse and children.
Many people fail to budget for deductibles and copayments. In 2022, original Medicare members must pay a $1,556 Part A deductible before their coverage takes effect. This is in addition to a Part B deductible of $233. Once the Part B deductible is met, Medicare will cover 80% of medical services, lab tests, and x-rays.
Joel Mekler, health benefits professional, health insurance expert and author of the weekly “Medicare Moments” column in the New Castle (Pennsylvania) News, says, “The sky is the limit when it comes to potential payouts unless that someone is going for a Medicare supplement or a Medigap plan. And Medigap plans essentially fill many of those gaps in the original Medicare. It would cover the Part A hospital deductible, the Part B deductible plus coinsurance and copayments. »
Original Medicare covers 90 days of hospitalization with deductibles and copayments per benefit period, says Jaime Fenimore, a Medicare specialist and broker based in Pittsburgh, Pennsylvania.
Over your lifetime, original health insurance will only cover a portion of hospitalization costs once you exceed 90 days of hospitalization during a benefit period. After 90 days, you draw on your so-called “lifetime reserve days,” which have higher copays.
“To understand lifetime reserve days, you first need to understand how Medicare defines a benefit period,” says Fenimore. “A benefit period begins the day you are hospitalized in a hospital or skilled nursing facility and ends when you have not received full hospital treatment for 60 consecutive days.
In other words, if you are hospitalized on May 1 and then again on June 15, you are still in the same benefit period because the two incidents are within 60 days of each other. And you only have to pay your deductible once.
However, Medicare will add the length of stay of the two hospitalizations during this benefit period, and if they are longer than 90 days, you will begin to use your lifetime reserve days. These 60 days of lifetime reserve are for single use only. Once they’re used, they’re gone for good.
Original Medicare does not cover routine dental exams, dental work, or dentures. Unless you have diabetes or need glasses after specific types of cataract surgery, original health insurance also does not cover vision care, including eye exams, corrective glasses or contacts.
However, most Medicare Advantage plans cover certain vision services. Likewise, although Original Medicare does not help cover the cost of hearing exams or hearing aids, some Medicare Advantage plans may.
Although Medicare Advantage plans often cover things like certain vision, dental, and hearing care that original Medicare does not cover, there may still be annual limits, such as the common dental limit of $1,500 per year. , or benefits may need to be received from a limited list of providers in order to be covered. Medicare Advantage members can also choose to purchase a separate dental plan.
If visits to the podiatrist are a regular part of your care plan, you will need to set aside money to cover the cost of these appointments unless they are medically necessary, as Medicare does not cover these. services if they are not medically necessary. Regular foot care services that are not covered include flat foot treatment, corn and callus removal, nail care, creams to maintain skin tone, and orthopedic footwear.
Medicare generally does not cover long-term nursing home care. However, even though the nursing home will not be paid for by Medicare, you cannot drop your coverage once you are admitted. You’ll still use your health insurance for many services, including hospital care and medical supplies while you’re in the nursing home, as well as doctor visits.
Most nursing homes accept Medicaid, so if you qualify for both and receive both Medicaid and Medicare, you will likely be covered for admission. Some people with Medicare choose to purchase a separate long-term care insurance policy to cover this level of care.
If you travel internationally frequently, you may want to consider that in most cases the original health insurance will not cover care outside of the United States. However, several Medigap plans available will cover 80% of these international medical costs. Some, but not all, Medicare Advantage plans will also cover emergency medical care needed outside the country.
Medicare will not cover cosmetic surgery costs, with some exceptions. For example, Medicare may choose to cover the prompt repair of severe burns, facial injuries after a serious car accident, or other surgical procedures for therapeutic reasons that also serve cosmetic purposes.
If you have any questions about the services covered by your health insurance plan, it is best to call the customer service phone number on the back of your insurance card. Another incredibly helpful service is the state health insurance assistance programs, which provide free, unbiased assistance and advice on a wide range of health insurance topics. With a little extra research, you can avoid costly and unnecessary medical bills.