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Medicare Coverage 7 Gaps You Need to Know About

Medicare Coverage | 7 Gaps You Need to Know About

Getting older comes with its perks – like senior discounts, the wisdom to appreciate a good nap, and Medicare.

Let’s talk about Medicare – the CARD that opens doors to doctor’s offices and pharmacies. Most people are pretty satisfied with it – why wouldn’t you be? BUT … it doesn’t cover everything, which may be a surprise to some of you. Those are the kinds of surprises we like to avoid … when it’s our health insurance.

A few things we ought to know – Let’s look at some gaps in Medicare and how we patch ’em up.

Prescription Drugs

First – outpatient prescription drugs. Have you ever been to the pharmacy assuming that Medicare’s got it covered, only to find out … surprise?! You’d think they’d throw your meds into the mix, right? Well – Parts A and B take care of a lot of things, but when it comes to prescriptions, you’re on your own. That’s where Part D prescription drug plans are going to be your friend.

Dental Care

How about dental care? That’s not part of the Original Medicare package either – no coverage for routine checkups, cleanings, x-rays, fillings, root canals, extractions, implants, bridges, or dentures. So you might want to look into a standalone dental plan or consider an Advantage plan that throws in dental benefits.

Vision Care

Vision care … It’s another one of those areas where Medicare comes up short. Original Medicare is GREAT for serious eye problems like cataracts and glaucoma. But routine exams, eyeglasses, and contact lenses? Nope – not on the menu. Some Advantage plans offer modest vision benefits … or you could go old-school and pay cash at the optometrist.

Hearing Exams and Hearing Aids

How about hearing, or the lack thereof ? Original Medicare helps with medical issues, but when it comes to routine hearing exams and hearing aids, Medicare’s not there for you.

Routine Physical

Moving on – You’d think a full annual physical exam would be a given, right? Well, you guessed … not exactly. Original Medicare offers what they call a “wellness” exam, which is about like asking for a full course meal and getting a snack instead. If you’re expecting a comprehensive physical exam … that’s on you.

Nursing Homes & Long-Term Care

Then there’s nursing homes and long-term care – now we’re getting into very tricky territory. Medicare helps with skilled nursing facilities for a limited time, and to kick things off, you’ll need a three-day hospital stay. But – it’s not a forever deal.

And custodial care for daily living activities? Forget about it – Medicare’s not going to write the check.

BOTTOM LINE – long-term care simply isn’t a Medicare thing, so whether it’s budgeting and saving or thinking about very expensive long-term care insurance, you need to have another plan.

Finally – Original Medicare doesn’t go with you outside the U.S., except in a few rare situations. You could be on the hook for medical bills if you need care out of the country.

Some * Medigap Supplement * plans offer a lifeline for emergencies abroad. Otherwise, you might want a separate travel insurance policy just to be safe and have peace of mind.

I know it sounds like we’re bashing Medicare, but realistically, it’s like the superhero of senior healthcare. It just has a few kryptonite moments, so you need to get familiar with the playbook. These are just some of the big potholes on the Medicare highway.

So whether you stay with Original Medicare and add a Medigap Supplement and a prescription drug plan -OR- enroll with an Advantage plan loaded with extra benefits, choose wisely. Knowing some of THESE things can help YOU make informed decisions about your healthcare.

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