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7 things Medicare doesn’t cover

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Medicare Parts A and B, also known as Original Medicare or Traditional Medicare, cover a large portion of your medical expenses after age 65. Part A (hospital insurance) helps pay for hospitalizations, stays in care facilities, palliative care and even some home health care. Part B (medical insurance) helps pay for doctor’s visits, outpatient care, some preventive services, and some medical equipment and supplies. Most people can start enrolling in Medicare three months before their 65th birthday.

It is important to understand that Medicare Part A and Part B Leave Sizable Gaps in Your Health Care Coverage. Here’s a more in-depth look at what’s not covered by Medicare, along with information on supplemental insurance policies and strategies that can help cover additional costs, so you don’t end up with medical bills. unexpected retirement.

Medicare does not cover outpatient prescription drugs, but you can purchase a separate Part D drug policy that does, or a Medicare Advantage plan that covers both medical and drug costs. (Some retiree health insurance policies also cover prescription drugs.) You can purchase Part D or Medicare Advantage coverage when you enroll in Medicare or when you lose other drug coverage. And you can change the policies during the open registration season each fall. Compare the costs and coverage of your specific medications under a Part D or Medicare Advantage plan using Medicare Plan Finder.

One of the biggest potential expenses in retirement is the cost of long-term care. The median cost of a private room in a nursing home was around $ 105,800 in 2020, according to the Genworth Cost of Care Study; a room in an assisted living facility costs $ 51,600 and 44 hours per week of care provided by a home help costs $ 54,900.

Medicare provides coverage for certain skilled nursing services, but not for on-call care, such as assistance with bathing, dressing, and other activities of daily living. But you can take out long-term care insurance or a combined long-term care and life insurance policy to cover these costs.

Part A of Medicare covers hospital stays and Part B covers medical services and outpatient care. But you are responsible for deductibles and co-payments. In 2022, you’ll need to pay a Part A deductible of $ 1,556 before coverage begins, and you’ll also need to pay part of the cost of long hospital stays – $ 389 per day for 61-90 days. in the hospital and $ 778 a day after that. Be aware: Over the course of your life, Medicare will only help you pay for a total of 60 days beyond the 90-day limit, called “lifetime reserve days,” and then you will pay the. full hospital costs.

Part B typically covers 80% of medical services, lab tests, and x-rays, but you will need to pay 20% of the costs after a $ 233 deductible in 2022. A medigap (Medicare supplement) or Medicare Advantage plan may fill. in the gaps if you do not have the additional coverage of a retiree health insurance policy. Medigap policies are sold by private insurers and come in 10 standardized versions that pick up where Medicare leaves off. If you purchase a medigap policy within six months of enrolling in Medicare Part B, insurers cannot reject or charge you more due to pre-existing conditions. See Choosing a Medigap Policy on Medicare.gov for more information. Medicare Advantage plans provide both medical and drug coverage through a private insurer, and they can also provide additional coverage, such as eye and dental care. You can change Medicare Advantage plans each year during the open enrollment season.

Medicare does not cover routine dental visits, dental cleanings, fillings, dentures, or most tooth extractions. Some Medicare Advantage plans cover basic cleanings and x-rays, but they typically have an annual coverage cap of around $ 1,500. You may also get coverage from a separate dental insurance policy or dental discount plan. An alternative is to accumulate money in a health savings account before signing up for Medicare; you can use the money tax-free for medical, dental, and other out-of-pocket expenses at any age (you cannot re-contribute to an HSA after you enroll in Medicare).

Medicare generally does not cover routine eye exams or glasses (exceptions include an annual eye exam if you have diabetes or glasses after having certain types of cataract surgery). But some Medicare Advantage plans offer vision coverage, or you can purchase a separate additional policy that provides only vision care or includes both dental and vision care. If you put money aside in a health savings account before enrolling in Medicare, you can use the money tax-free at any age for glasses, contact lenses, eyeglasses, prescription sun and other reimbursable vision care costs.

Medicare does not cover routine hearing tests or hearing aids, which can cost up to $ 3,250 per ear. But some Medicare Advantage plans cover hearing aids and hearing aid exams, and some reduction programs offer hearing aids at a lower cost. If you save money in an HSA before signing up for Medicare, you can also use it tax-free for hearing aids and other personal expenses.

Medicare generally does not cover the care you receive when traveling outside of the United States, except in very limited circumstances (such as on a cruise ship within six hours of a US port). But some medigap plans will cover 80% of the cost of emergency care abroad up to a certain limit. In addition, some Medicare Advantage plans cover emergency care abroad. Or you can purchase a travel insurance policy that covers certain medical expenses while you’re outside of the United States and can even cover emergency medical evacuation, which can otherwise cost tens of thousands of dollars for transport you aboard a medical plane or helicopter.

To find Medicare coverage rules and other types of care and procedures, go to Medicare.gov/coverage and use the section “Is my test, item, or service covered?” ” tool. See also what the original health insurance covers. If you believe a claim has been unfairly denied, see How to appeal a denied health insurance claim.

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