What Medicare Does—And Does Not—Cover

(4 Minute Read)

Some people over the age of 65 think of Medicare as a life raft, keeping them afloat in their retirement. Others see it as a life raft, sure, but one that is taking on water. For those who are currently thinking about retirement, knowing what to expect from your health care insurer can help you smoothly sail into your golden years. Just as important is knowing what Medicare doesn’t cover will help you stay healthy and solvent.

Medicare Part A

Medicare Part A is the section of Medicare that covers a patient while they are being treated in a medical facility. While we may immediately think of hospitals and emergency rooms, this also means that you can receive benefits in a skilled non-custodial nursing facility. These are places where seniors are assisted by skilled nurses that provide 24 hour care and services that can’t be done by a non-medical professional, unlike a traditional nursing home that usually only provides custodial care like help with bathing or getting dressed.

Medicare can also cover some home healthcare. Nobody likes staying in a hospital and this could be an option for those who have been deemed by a doctor as homebound and has a manageable health problem, which means that your doctor can attest that you need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy. That being said, there are very specific cases in which Medicare will help with home healthcare and is usually restricted to a maximum of eight hours a day for up to 21 days. So, if home healthcare is something you may need, make sure to look into supplemental plans that will help cover the costs that Medicare won’t.

In the event that you or someone you love needs hospice (or end-of-life) care, Part A will help defer the cost of this as well, providing grief and loss counselors for  the policy holders’ survivors and even the patient themselves if needed to help cope in that very trying time.

Medicare Part B

Part B (medical insurance) is more focused on the service and equipment side of the healthcare field. This section was designed to help if you need a service and/or equipment that may work to diagnose and treat your medical problem and help improve your quality of life.

If there is a clinical trial for a new treatment, Part B will cover at least 80% of your participation in it. It will also cover ambulance and air transportation, if there is no other way for you to get to the closest medical facility safely.

Medicare Part B also helps with preventative care. This includes services like cancer screening and flu shots. Basically, if there is a test that can find an illness in its early stages, Medicare will cover the cost, as treatments are more effective the earlier they are caught. This could possibly save your life and save you from spending money on lots of costly out-of-pocket deductibles down the road. If you’re still not sure if an important procedure or equipment is covered, you can go here to find out more.

One of the most useful aspects of Medicare Part B is that it covers durable medical equipment (like crutches, blood sugar monitors, and hospital beds) as long as there is a medical reason for needing this equipment and can be repeatedly used for at least three years. Part B also covers a myriad of mental health services. This includes some inpatient, out-patient, and partial hospitalization in a mental health facility.

What Medicare Doesn’t Cover

If you’re reaching retirement age, you could need to spend on average $280,000 on healthcare over the rest of your lifetime. That’s a huge number, plus you should consider the services that the program doesn’t cover. This could make that number go much higher. The list below is not a comprehensive one, so if you have any questions, check out the Center for Medicare and Medicaid outreach page to find more information.

• Long Term Custodial Nursing Home Care
  • Up to two-thirds of people will need this after they retire which can cost up to $92,000 a year, with little help from Medicare.
• Most Long Term In-Home Care
  • To get long term care in-home covered by Medicare, you must get a special waiver, and this waiver is strictly limited
• Dental Plans
  • Medicare does not cover dental services, but are covered by Medigap plans
• Hearing Aids
  • Can range from $1,000 to $4,000 each and Medicare doesn’t help.
• Vision Plans
  • Will only help with glaucoma screening and surgeries, but will not help with regular vision check-ups or with the purchase of glasses or contacts.

There are some great programs to help retirees on a fixed income with vision and dental concerns, but you can’t always count on them for help.

Everyone envisions smooth sailing when it comes to retirement, but health problems, like a tidal wave, can hit you unexpectedly. Why not avoid the stormy weather as much as possible by doing everything in your power to prepare for retirement? If you have been paying into a life insurance policy and find that you no longer need it or don’t want to make your monthly payments anymore, you have an option other than surrendering the policy. Did you know you can sell all or a portion of a life insurance policy, even term insurance? You can sell the policy for a lump sum higher than the surrender value offered by the insurance company, providing you with a nest egg to rely on.

Leo LaGrotte
Life Settlement Advisors
llagrotte@lsa-llc.com
1-888-849-0887

Download our resource, How to Plan for Healthcare Costs in Retirement, for more information on common age-related health issues, their costs, and how you can pay for the care you need.