AARP estimates that 15% of U.S. citizens rely on Medicare, but it only covers about half of their total health costs. In fact, Medicare patients spent an average of $3,138 on out-of-pocket healthcare costs in 2007.
That begs the question: how much does Medicare cover? What isn’t covered?
Keep reading to find out five surprising things that aren’t covered by Medicare.
1. Medicare Doesn’t Cover Residential Care
Medicare Part A coverage does include most hospital services. These covered services must take place in an inpatient setting.
This means long term-residential care isn’t covered.
Medicare Part A hospital coverage may include:
- Skilled nursing facility
- Inpatient rehabilitation facility
Assisted living care or non-medical residential care isn’t covered at all.
Instead, many seniors rely on Medicaid. Medicaid does not cover room and board expenses.
2. Prescription Drugs Aren’t Covered
When questioning what doesn’t Medicare cover, prescriptions have to be the most surprising.
Surveys reveal that 80% of those over 65 take at least two prescription drugs. So, how are they affording these costs?
Individuals usually buy Medicare advantage plans or Part D prescription plans. Otherwise, those over 65 must find other ways of saving money on their prescriptions.
3. How Much Does Medicare Cover Regarding Hearing Tests?
About one in four individuals over 65-years-old have disabling hearing loss. That number increases to 50% in seniors greater than 75-years-old.
Hearing loss tests are only covered in limited circumstances. Medicare Part B coverage will support hearing tests ordered for a medical need.
If your hearing loss is due to a recent injury or an illness, then it’s included.
Parts A and B won’t cover routine hearing exams, fittings for aids, or the hearing aids themselves.
4. What About Deductibles and Co-Pays?
Those enrolled in Medicare are completely responsible for co-pays and deductibles.
Part B coverage covers about 80% of doctor’s services and outpatient care. The patient handles the rest.
It’s shocking to most that Medicare patients will also have to pay for hospital stays that exceed 90 days.
Medigap coverage can reduce these costs, but it isn’t included in Parts A and B.
5. Does Medicare Cover Dental and Vision?
It’s true that the intention of Medicare is to provide “medically necessary” care to those who need it. According to lawmakers, vision and dental care do not fall under this scope.
Under limited circumstances, Medicare may cover emergency inpatient hospital dental treatment.
Routine dental care, extractions, fillings, or other care is never covered under Parts A or B.
One of the benefits of Medicare Advantage plans is that they can help cover dental and vision costs. Some Medicare supplemental insurance plans offer dental or vision care.
Medicare Pays for About Half of All Health Costs
So, how much does Medicare cover?
In all, only about half of all health-related costs.
The above five excluded costs are only a small fraction of what isn’t covered. For the most part, gaps in coverage get paid through other insurance policies or out of pocket.
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