5 Health Care Costs That Medicare Does Not Cover

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Turning 65 brings access to senior discounts galore, but there is no benefit of senior citizenship quite like Medicare.

The federal program extends subsidized medical insurance primarily to folks age 65 and older. But, while Medicare coverage comes with numerous freebies, it is hardly free.

Medicare beneficiaries pay into the system via taxes withheld from their paychecks during their working years. Additionally, Medicare coverage is not all-inclusive: Beneficiaries must cover all or part of certain medical expenses.

If you are already on Medicare, you already know that — perhaps painfully well. But the costs associated with coverage can come as a surprise to folks who have yet to sign up for Medicare.

So, below is a look at some of the most expensive, most common and most surprising health care costs that Medicare does not cover.

Good to know: Your out-of-pocket costs under Medicare will vary depending on your coverage type. When enrolling in Medicare, you’ll choose between two main types of Medicare:

  • Original Medicare plans, which are offered directly by the federal government’s Medicare program
  • Medicare Advantage plans, which are offered by private insurers that are approved by the Medicare program

Medicare Advantage plans must cover all the same services that Original Medicare covers. Some Medicare Advantage plans cover other expenses, too. So, as you read on, remember that some costs may not apply with certain Medicare Advantage plans.

1. Premiums

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You may be surprised to find that even federally subsidized health insurance has premiums.

For 2019, the standard monthly premium for Part B — the component of Medicare plans that covers services you receive outside of a hospital — is $135.50 or more, depending on your income. Usually, the Part B premium is deducted from your Social Security benefits check.

Seniors with Medicare Advantage usually pay a premium for their plan in addition to the standard Part B premium.

One bit of good news: A vast majority of seniors do not pay a premium for Medicare Part A, which covers inpatient hospital services, as we reported in “3 Major Medicare Costs That Will Increase in 2019.”

How to lower your costs: The Part B premiums are fixed. There’s nothing you can do about them.

If you have Original Medicare, you have the option to buy a supplemental insurance plan, also known as a Medigap plan, which would pay for some expenses that Original Medicare does not cover.

The catch: The Part B premium isn’t among the costs that Medigap plans cover. So, you will still have to pay it — plus the premium for the supplemental plan.

Is the extra cost of a Medigap plan worth it? In many cases, yes — especially if you were to face big medical bills. To learn more, see “How to Pick the Best Medicare Supplement Plan in 4 Steps.”

2. Long-term care

Nursing Home
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Long-term care refers to medical and nonmedical services for people who are unable to perform basic daily tasks like dressing or bathing on their own. You may receive long-term care in your home, in the community or at an assisted living facility or nursing home.

Like most health insurance plans, Medicare generally does not cover long-term care costs, which are notoriously high.

In 2018, the national median cost of a full-time home health aide was $4,195 per month, according to Genworth, a company that provides long-term care insurance. The median monthly cost for a private room was $4,000 at an assisted living facility and $8,365 at a nursing home.

How to lower your costs: Start by considering long-term care insurance. For help determining whether it would be a smart buy for you, check out Money Talks News founder Stacy Johnson’s article “Ask Stacy: Should I Buy Long-Term Care Insurance?

3. Dental care

Dental patient
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Some Medicare Advantage plans may cover some dental services. It depends on the specifics of the plan.

Original Medicare does not cover most dental care, procedures or supplies — including:

  • Cleanings
  • Fillings
  • Tooth extractions
  • Dentures
  • Dental plates
  • Other dental devices

There are some exceptions. For example, Original Medicare covers certain dental services that you get while in a hospital. But aside from exceptions, seniors on Original Medicare plans are stuck paying for 100% of their dental expenses.

How to lower your costs: Check out “4 Ways to Get Free or Low-Cost Dental Care.”

4. Hearing aids

Otolaryngologist putting hearing aid in woman's ear
Pixel-Shot / Shutterstock.com

You might think that an insurance program for seniors would cover hearing aids, but that’s not necessarily so.

Some Medicare Advantage plans may pay for hearing aids, but not all do.

Original Medicare doesn’t cover them. You are responsible for 100% of the cost of hearing aids themselves and exams to fit hearing aids.

Original Medicare generally does cover 80% of the Medicare-approved cost of diagnostic hearing exams — meaning those that a health care provider orders to determine whether you need medical treatment. The patient or the patient’s Medigap plan pays the other 20%, though a deductible applies.

How to lower your costs: Check out “Now Hear This: You Can Save Hundreds on Hearing Aids.”

5. Routine vision care

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Some Medicare Advantage plans cover some vision-related expenses. Any coverage varies with individual plans.

Original Medicare, though, does not cover routine eye exams. So, 100% of the cost of their cost is on you.

More bad news: Original Medicare typically does not cover eyeglasses or contact lenses.

Original Medicare does cover eye exams for patients with diabetes. It also covers tests for glaucoma and macular degeneration. It even covers artificial eyes that your doctor orders. So, a senior on Original Medicare is responsible for only 20% of such expenses, after a deductible.

How to lower your costs: Check out “4 Steps to Finding Stylish and Cheap Eyeglasses.”

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