Navigating the complexities of Medicare can feel overwhelming, especially as you approach retirement or assess your health coverage options. While Original Medicare (Part A and Part B) offers critical health care benefits, it doesn’t cover everything, leaving potential gaps in your coverage. Understanding what’s missing and how to address these gaps is essential for maintaining your health and financial security. Below, we’ll explore what Original Medicare does not cover, and the additional options available to help fill the gaps in your healthcare coverage.
What Does Original Medicare Cover?
Before we discuss what’s excluded, it’s important to understand what Original Medicare (Parts A and B) does include. Part A primarily covers hospital stays, skilled nursing facility care, hospice care, and some home health services. Part B, on the other hand, focuses on outpatient care, including doctor’s visits, preventative services, certain therapies, and medical equipment. These offerings form the foundation of health coverage for many seniors but have some critical exclusions that you should be aware of.
What Original Medicare Does Not Cover
Though comprehensive in many ways, Original Medicare does not provide coverage for a number of key healthcare services that may become increasingly important as you age. Here’s what’s missing and why it matters:
Dental Care
Original Medicare does not include routine dental care, such as cleanings, exams, fillings, or dentures. Given that proper oral health is a vital part of overall wellness, lack of dental coverage can lead to out-of-pocket expenses that add up quickly.
Vision Services
Eye exams related to glasses or contact lenses, as well as the cost of eyewear itself, are not covered by Original Medicare. The exception is diagnostic eye exams for conditions like glaucoma or macular degeneration. Seniors often find that paying for prescription glasses or necessary corrective surgery, such as cataracts procedures, can strain their budget.
Hearing Aids
Hearing loss is common as individuals age, yet hearing aids and the exams required to fit them are not covered. These devices can cost thousands of dollars, representing another gap in medical coverage that can significantly impact quality of life.
Long-Term Care
If you require custodial care, such as help with daily activities like bathing, dressing, or eating, Original Medicare does not cover the cost. Long-term care in a nursing home or assisted living facility falls outside the scope of its benefits, often leaving individuals to rely on savings or other insurance products to cover these expenses.
Prescription Drug Costs
While Part B may cover certain outpatient drugs administered during a medical procedure, Original Medicare does not include most prescription drugs. Beneficiaries must choose a standalone Part D plan or another service to manage these costs.
How to Fill the Gaps
The good news is that you have options to address the limitations of Original Medicare. Many seniors turn to Medigap (Medicare Supplement) plans or Medicare Advantage plans to fill these gaps and improve their access to comprehensive care.
Medigap (Medicare Supplement Plans)
Medigap plans are designed to work alongside Original Medicare, covering costs such as copayments, coinsurance, and deductibles. While specific benefits vary by plan, here are some common gaps Medigap can help fill:
- Deductibles for Part A and Part B services: Medigap may cover some or all hospital and outpatient deductibles, depending on the plan you choose.
- Excess charges: These are additional costs when providers charge more than the Medicare-approved amount.
What It Doesn’t Cover: While helpful with cost-sharing, Medigap doesn’t extend to coverage for dental, vision, or hearing needs.
Medicare Advantage Plans
Medicare Advantage plans (also known as Part C) offer an alternative to Original Medicare, combining Parts A and B and often incorporating additional benefits. Here’s how they can help fill coverage gaps:
- Dental, Vision, and Hearing: Many Medicare Advantage plans include coverage for dental exams, cleanings, eyeglasses, contact lenses, and hearing aids.
- Prescription Drugs: Most plans combine health coverage with Part D benefits, offering affordable access to medications.
- Fitness and Wellness Programs: Some plans offer perks like gym memberships to help you stay active and healthy.
Flexible Options: Medicare Advantage plans vary widely in both cost structure and benefits, so choosing the right plan tailored to your needs is essential.
Standalone Insurance Products
For services not included in Medigap or Medicare Advantage, purchasing standalone insurance is an additional option. For example, standalone dental, vision, or long-term care insurance can provide tailored benefits to address your specific needs.
Why It’s Important to Plan Ahead
Understanding what Medicare covers—and just as importantly, what it does not cover—is critical for financial and health planning. As health care costs continue to rise, having supplemental coverage can protect you from unexpected expenses and ensure you receive the care you need without financial strain.
Need Help Making Sense of Medicare Advantage?
Mint Insurance Agency Is Here to Help.
We are an insurance agency dedicated to becoming a lifetime partner for your Medicare and health coverage needs. If you need assistance or want to learn more about the alternatives available to you, contact our licensed agents today or call 1.888.225.MINT (6468). Our team is ready to answer all your questions and help you make the right decision for your circumstances.
