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Many people assume that when they retire, Medicare will pick up all of their healthcare costs. Unfortunately, this mistake can create big problems when a senior goes in for a procedure and ends up with an unexpected bill.
While Medicare has some pretty surprising gaps in coverage, private insurance plans can help cover those gaps. If you are interested in additional coverage to help with your Medicare, Medicare supplements and Medicare Advantage plans are good options.
Let’s take a closer look at what Medicare alone doesn’t cover.
Copays, Coinsurance, and Deductibles
When you have Original Medicare (Medicare Part A and Part B), you will be responsible for a portion of the cost of many services. Part A and Part B both have deductibles. Once the deductible is met, there may also be copays or coinsurance amounts. With Medicare, there is no maximum out-of-pocket (MOOP) amount. Not having a MOOP means there is no cap on how much you can spend on copays and coinsurance with Medicare alone.
Prescription Drugs
Medicare doesn’t cover most prescription drugs. So for someone with Medicare to have coverage for their medications, they need to enroll in a Part D plan either as a stand-alone plan or as part of a Medicare Advantage plan. There may be a penalty if someone has Medicare and doesn’t enroll in a Part D plan when they are first eligible.
Dental
Medicare doesn’t cover most dental procedures, including routine cleanings, X-rays, dentures, etc. However, Medicare Part A will cover some dental procedures when the member is a hospital in-patient. To have comprehensive dental coverage, the member may enroll in a stand-alone dental plan or a Medicare Advantage plan that includes dental.
Hearing
Many people are surprised that Medicare does not cover routine hearing exams and hearing aids. Once again, Medicare Advantage plans may be a good option for people seeking help with the cost of these items.
Vision
Medicare only covers medically necessary vision services, such as cataract surgery. Routine eye exams and eyeglasses are generally not covered. Although many Medicare Advantage plans offer vision coverage, check specific plans for details on how much coverage they offer.
As you can see, there are some surprising gaps in Medicare coverage. As a result, Medicare supplements and Medicare Advantage plans may be good options for people seeking more coverage.
Everyone’s situation is unique. We are here to help match you with the plan options that best fit your needs. Speak to a local agent today for a free, no-obligation review of your current plan, or ask questions about other options. Give us a call at (800) 398-8714.
Christina Valenzuela
Christina Valenzuela is the co-owner of Vista Mutual Insurance Services, an insurance agency that focuses exclusively on the needs of Medicare beneficiaries. She has worked in the Medicare insurance industry since 2006 and is a licensed insurance producer in multiple states.
Although we strive to be as accurate as possible, any differences between this document and the information on Medicare.gov will be governed by the information on Medicare.gov.
