By the time a person turns sixty-five, they probably know what health insurance does and doesn’t cover. But Medicare is different— and some surprising things aren’t covered under Medicare’s umbrella. Medicare is the federal government’s insurance coverage for people aged sixty-five and older and those with disabilities and chronic conditions. Here are some things Medicare doesn’t cover:
Deductibles and Coinsurance
If one opts for Original Medicare, Medicare Part A, and Part B require out-of-pocket spending in deductibles and coinsurance. If a person has medical needs, this can get expensive, and there’s no out-of-pocket cap on Original Medicare expenses.
“Many people on traditional Medicare get a Medigap plan to help cover those costs and make their out-of-pocket costs more predictable,” says Gretchen Jacobson, Vice President of a private corporation that promotes a high-quality health care system.
If one enrolls in a Medicare Advantage plan from a private insurance company, the company will pay the deductibles, copays, or coinsurance required when the patient seeks health care. Though there’s an out-of-pocket maximum for Medicare Advantage, that amount can be as high as $8,300 in 2023.
Routine Dental Care
Though Medicare Part A covers a few dental services, primary dental care like cleanings, X-rays, or fillings aren’t covered. If a person wants coverage, they must purchase a separate dental policy.
One may get coverage by opting for a Medicare Advantage plan with dental benefits. “But those benefits can be limited, or Medicare Advantage plans can ask patients to pay extra for those benefits,” says Lina Walker, vice president of AARP’s Public Policy Institute.
Eye Exams
Medicare doesn’t cover eye exams for contacts, glasses, or eyeglasses or contacts themselves. Medicare Part B covers one pair of glasses or contacts if a person has cataract surgery. One may be able to get some coverage by purchasing a Medicare Advantage plan with vision benefits.
Hearing Aids
Medicare doesn’t cover hearing aids or the tests required for hearing aids. While there’s a request in the Build Back Better Act to add hearing aid coverage to Medicare, the act hasn’t made it to Congress. Medicare does cover diagnostic hearing exams if a doctor thinks their patient needs them. One may get coverage by purchasing a Medicare Advantage plan with hearing benefits.
Prescription Drugs
Parts A and B don’t offer coverage for prescription drugs. If a person wants prescription drug coverage, they must buy a Medicare Part D plan from a private company or get prescription drug coverage from a Medicare Advantage plan that includes it. Medicare drug coverage is optional, but a person can choose to skip it.
