Many people approaching age 65 are surprised to learn that Medicare does not cover every healthcare expense. While Medicare provides valuable health insurance protection, there are important gaps that can leave beneficiaries responsible for significant out-of-pocket costs.

Understanding what Medicare does not cover can help you make informed decisions about Medicare Supplement insurance and other types of coverage.

Long-Term Care

One of the biggest misconceptions about Medicare is that it covers long-term care.

Medicare may pay for a limited stay in a skilled nursing facility following a qualifying hospital stay, but it generally does not cover custodial care. Custodial care includes assistance with activities of daily living such as bathing, dressing, eating, and personal care when that is the primary need. The cost of long-term care can be substantial, making it important to plan ahead.

Routine Dental Care

Original Medicare generally does not cover routine dental services such as:

• Regular cleanings
• Dental exams
• Fillings
• Crowns
• Dentures
• Most tooth extractions

Because dental expenses can add up quickly, many beneficiaries choose to purchase separate, stand-alone, dental insurance. Many dentists offer their own dental plans, so you should also check with your dentist.

Routine Vision Care

Medicare does not typically cover routine eye exams for glasses or contact lenses.

Most beneficiaries are responsible for:

• Eye exams for prescription glasses
• Eyeglasses
• Contact lenses
• Lens upgrades

Medicare may cover certain medically necessary eye treatments and surgeries, but routine vision care is generally excluded.

Hearing Aids

Hearing loss is common among older adults, yet Medicare generally does not cover the following:

• Hearing aids
• Hearing aid fittings
• Routine hearing exams for hearing aid purposes

Since hearing aids can cost thousands of dollars, many beneficiaries seek separate coverage or discount programs.

Medical Care Outside the United States

Many people are surprised to learn that Medicare provides very limited coverage outside the United States.

Some Medicare Supplement plans include a foreign travel emergency benefit, but coverage is limited and subject to certain conditions. If you plan to travel internationally, purchasing a travel medical insurance policy is a wise decision.

Prescription Drug Costs

Original Medicare does not provide comprehensive prescription drug coverage.

Beneficiaries who want prescription drug coverage typically enroll in a Medicare Part D prescription drug plan (PDP) or choose a Medicare Advantage plan that includes drug coverage. Without prescription coverage, medication costs can become very expensive.

It’s also important to understand that Medicare beneficiaries who do not enroll in a Medicare PDP when they are first eligible for Medicare may face a late enrollment penalty if they decide to enroll later. This penalty is generally added to their Part D premium and can continue for as long as they have prescription drug coverage.

Even individuals who currently take few or no medications may want to consider enrolling in a low-cost Part D plan when first eligible in order to protect themselves from future penalties and ensure they have coverage in place if their prescription needs change. Some PDPs have a $0 monthly premium, but the best PDP depends on what medications someone takes.

California Health Insurance Counseling and Advocacy Program

In California (and other states) there is a volunteer organization called California Health Insurance Counseling and Advocacy Program (HICAP). They provide FREE prescription drug plan counseling. You can call them and set up an appointment to see someone at a local office or they may be able to answer your questions over the phone.

Here is their contact information:

California Health Insurance Counseling & Advocacy Program (HICAP)
https://www.shiphelp.org/ships/california/
800-434-0222

Most Cosmetic Procedures

Medicare generally does not cover procedures performed solely for cosmetic reasons, including elective surgeries intended to improve appearance rather than treat a medical condition.

Why Most People Choose Medicare Supplement Insurance

While Medicare Supplement insurance does not cover dental, vision, hearing aids, or long-term care, it can help pay many of the out-of-pocket costs left behind by Original Medicare (Parts A and B) such as deductibles, copayments, and coinsurance.

Original Medicare provides valuable coverage, but it does not cover all healthcare expenses. For many covered Part B services, beneficiaries are responsible for 20% of the Medicare-approved amount after meeting the Part B deductible. In addition, Original Medicare does not have a yearly out-of-pocket maximum for these costs, which can make healthcare expenses difficult to predict.

A Medicare Supplement plan helps reduce some of these out-of-pocket expenses and provides greater financial predictability. This added protection offers greater confidence when planning for future healthcare costs.

As an independent insurance agent, I help clients compare Medicare Supplement options from multiple insurance companies. Since Medicare Supplement plans with the same letter designation offer the same standardized benefits, comparing carriers can help identify differences in premiums, pricing stability, and customer service.

Final Thoughts

Medicare is an excellent health insurance program, but it was never designed to cover every healthcare expense. Understanding these coverage gaps can help you avoid unexpected costs and build a more complete healthcare strategy.

If you have questions about Medicare Supplement plans or would like to review your coverage options, feel free to contact me. I am always happy to help you understand your choices and find coverage that meets your needs.

About the Author

I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, Arizona, and several other states.

I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.

I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, there is a law called the California Birthday Rule, which allows Medicare Supplement policyholders to change their plans each year during the 60 days following their birthday without answering health questions or going through medical underwriting. During this annual 60-day enrollment period, you cannot be turned down for coverage when changing to a Medicare Supplement plan with the same or fewer benefits.

I regularly help clients lower their Medicare Supplement premiums while keeping the same benefits and coverage.

Over the years, I have helped many clients save hundreds and sometimes even thousands of dollars on their annual premiums.

There is never a fee for my services because I am compensated by the insurance companies, not my clients. My goal is to help you find competitive premiums while providing dependable, personal service year after year.

If you’re turning 65 or already have a Medicare Supplement plan and would like to review your options, I’m happy to help.

Read what my clients have to say about working with me.

Contact Information

Ron Lewis
Independent Medicare Supplement Insurance Specialist

Cell: (760) 525-5769

Toll-Free: (866) 718-1600

Email: Ron@RonLewisInsurance.com

Website: www.MedigapShopper.com

Insurance Licenses

• California: #0B33674
• Nevada: #3822123
• Arizona: #681166

This website is operated by a licensed insurance agent and is intended for educational purposes only. I am not affiliated with or endorsed by Medicare or any government agency.