What Isn’t Covered by Original Medicare?
If you choose to enroll in Original Medicare, it covers most of your healthcare needs after you turn 65 or if you qualify earlier due to certain disabilities or End Stage Renal Disease (ESRD). Original Medicare Part A covers inpatient hospital stays, surgeries, skilled nursing facilities, and some hospice and home care. Original Medicare Part B covers doctor visits, preventative services, durable medical equipment and supplies, and outpatient care. With all that coverage, Original Medicare still leaves you are responsible for some out-of-pocket costs, and there are still services left uncovered. If you choose to keep your Original Medicare coverage, enrolling in a Medicare Supplement, aka Medigap, plan can help fill in some of these gaps. You also have the option to opt for a Medicare Advantage (Part C) plan; these plans offer at least as much coverage as Original Medicare Parts A & B. They also may include additional benefits as well as prescription drug coverage.
Here are a few things Original Medicare Parts A & B don’t cover.
Prescription Drugs
Original Medicare Part A & Part B do not cover prescription drugs. You will need to enroll in a standalone Medicare Part D Prescription Drug Plan to receive prescription drug coverage (and avoid penalties ) if you plan on enrolling in Original Medicare. You can enroll in Medicare Part D during your initial enrollment period. If you choose to enroll in a Medicare Advantage (Part C) Plan, prescription drug coverage may be included.
Long-Term-Care
Original Medicare Parts A & B do not cover long-term care. While some of the care in a skilled nursing facility may be covered, not all is. The average cost of a nursing home is upwards of $100,000 without any form of insurance. There is long-term care insurance to help individuals cover these costs.
Co-pays and Deductibles
Although Original Medicare covers trips to the doctor’s office, hospital stays, or any outpatient care, you still have to pay co-pays or deductibles. Original Medicare Part A will require a deductible before coverage begins, and you must pay a portion of the cost of a long hospital stay starting at day 61. Original Medicare Part B will also require a deductible, but you also must pay 20% of the costs of doctors’ services with Part B. Medicare Supplements can help ease the burden of some of these costs.
Dental and Vision Care
Most routine dental care is not covered by Original Medicare. Routine visits, cleanings, fillings, extractions, and dentures will have to be covered by a separate insurance plan if you choose to enroll in Original Medicare. Some Medicare Advantage (Part C) Plans can cover these basic cleanings and X-rays, but these plans have an annual coverage cap (as may some standalone dental plans). Routine vision care is also not covered by Original Medicare. There are exceptions to this, such as if you have diabetes or must have cataract surgery; you may get an annual eye exam through this exception. Some Medicare Advantage (Part C) Plans include routine vision care. For those choosing to enroll in Original Medicare, you may want to consider a standalone vision insurance plan.
Hearing Care
Hearing aids are another essential healthcare item for many. However, unfortunately, Original Medicare does not cover hearing aids or routine hearing exams. Just like vision or dental, some Medicare Advantage (Part C) plans may be able to cover hearing care costs. Standalone hearing care plans are also an option.
Traveling Abroad
Any care you receive while abroad will not be covered by Original Medicare. However, some Medicare Supplements offer emergency care coverage when traveling abroad.
Choosing the Best Coverage for Your Needs
It’s important to fully understand the coverage you will receive, regardless of which type of plan you choose to enroll in when the time comes. For some people, Original Medicare and a Medicare Supplement provide the most effective mix of coverage, along with a Medicare Part D Prescription Drug Plan. Others may find the best option for their needs & budget is to enroll in a Medicare Advantage (Part C) plan. If you have questions about evaluating your Medicare options, give us a call for a no-cost, no-obligation coverage review.
