Medicare doesn’t cover everything. Here’s how to avoid surprises

Every day in the United States, about 10,000 babies celebrate their 65th anniversary^order birthday. The gift from their good old Uncle Sam is Medicare.

After years of paying payroll taxes at work to help fund this government program, these older Americans are finally getting their turn to sign up and have health insurance for the rest of their lives.

However, many new enrollees are surprised to discover that basic Medicare doesn’t cover a wide range of health care costs that can hit retirees quite heavily.

“Many people on this plan think they will get everything covered,” says Roger Luchene, a Medicare agent with Hammer Financial Group in Scheerville, Indiana. “The three big factors are dental, vision and hearing. I’m really surprised how many people think it’s covered.”

About 48 million Americans age 65 and older are on Medicare, as are about 9 million other young people with disabilities.

Fidelity Investments estimates that the average couple who retires today at age 65 will spend $280,000 on health care for the rest of their lives.

Some low-income people qualify for programs that reduce their Medicare-related costs. More help with prescription drug coverage is available, and some state-run savings programs can help with copays, coinsurance, deductibles, and premiums.

For those who do not qualify, paying out-of-pocket or purchasing additional insurance are their options.

Here are some common things that basic Medicare doesn’t cover and how to prepare.

Basic, or original, Medicare consists of two parts: Part A and Part B.

Part A provides coverage for hospital stays, skilled nursing, hospice, and some home health services. As long as you have at least 10 years of work history, you pay nothing for Part A. However, it comes with a $1,340 deduction for each benefit period and there is an annual limit on benefits .

Part B coverage goes into effect when you see a doctor or get other outpatient services, such as a flu shot. It also includes medical equipment, like crutches or blood glucose meters.

This year the monthly premium for Part B is $134 for those earning up to $85,000. If you make more than that, you’ll pay more (see chart below.) It also comes with a $183 deductible. Once it’s met, you typically pay 20 percent for services. insured service.

(Source: Centers for Medicare and Medicaid Services. *Part B premiums are based on tax returns from two years ago. So for 2018, it’s based on your 2016 return.)

Basic Medicare (again, parts A and B) doesn’t cover prescription drugs, although you do have the option of getting coverage when you first sign up for Medicare. If you don’t choose and change your mind later, you’ll pay a lifetime penalty unless you meet certain exclusions (i.e. you get acceptable coverage through a union or employer). motion).

You can get this coverage through a stand-alone prescription drug plan (Medicare Part D) or through a Part C plan, also known as a Medicare Advantage Plan.

If you go with the latter, which usually includes some additional benefits on top of basic Medicare, your Part A and Part B coverage will also be provided through the insurance company that offers the plan.

In general, original Medicare does not cover routine dental work and vision or hearing care.

This means it doesn’t include dentures, which can run anywhere from around $1,000 to north of $5,000 for a complete set. And while routine cleanings and X-rays can cost you around $200 and fillings around $150 or $200, a single implant can run up to $4,000.

However, if the dental condition involves an urgent or complicated procedure, it may be covered.

The same goes for routine vision checks. If you need glasses, it’s usually not covered. However, if you have an eye disease such as glaucoma or cataracts, basic Medicare will cover your care.

If you decide to use the Advantage Plan, you have a good chance of getting dental and vision coverage. However, it will likely be limited.

“You get some coverage, but nothing major,” says Elizabeth Gavino, founder of Lewin & Gavino in New York, an independent broker and general agent for Medicare plans. “You may get a teeth cleaning every year or two.”

Whether you choose an Advantage plan or stick with basic Medicare, you can purchase a separate policy that gives you more extensive coverage.

Hammer Financial’s Luchene says standalone vision plans can cost around $9 a month, and dental plans can run somewhere in the neighborhood from $30 to $50 a month, depending Depends on the coverage you choose to receive.

Some plans will add hearing coverage, although there is usually a low maximum — for example, $500 — that the plan will pay. Hearing aids can cost anywhere from $1,000 to $4,000 or so.

If your future plans include moving from one country to another, note that basic Medicare usually does not cover care you receive outside of the United States.

“If you have a heart attack overseas or have to be transported by plane… those things can be very expensive,” says Gavino.

If you choose the Advantage Plan, emergencies are generally covered worldwide. However, routine care received abroad may not.

In this situation, you might consider health-travel policies that specifically target people 65 and older. Depending on the specifics of your coverage and your age, these policies can cost around $175 or so a month.

According to a 2017 bipartisan Policy Center report, the average American turning 65 today will spend $138,000 on long-term care costs in the future. Long-term care includes things like help with bathing and eating every day.

In general, Medicare does not cover long-term care. There are insurance policies that cover it, although they can be expensive. And the older you get, the more they cost.

For example, the rate for a couple, both 55 years old, would pay about $2,500 for an annual policy that provides $164,000 in coverage per policyholder, according to the Association of Long-Term Care Insurance. United States term. If they’re 60 years old, that’s about $3,400.

If you go to the hospital, make sure you are hospitalized or are there for observation. It can make a big difference in how much Medicare pays if your aftercare involves skilled nursing.

Let’s say you travel and fall and end up in the hospital. You stay there for a few days. After you leave, you need to rehabilitate your injury.

Such skilled nursing care is covered through Medicare Part A if you have been hospitalized for at least three days. However, if the hospital keeps you there to monitor you instead of admitting you, your detox will not be covered.

“Observation is considered outpatient,” says Gavino. “So then you have a huge bill because you weren’t admitted as an inpatient. And in some cases they wouldn’t admit you even if you asked.”

There are hospital compensation plans that can cover up to $600 per day for certain days. Depending on your coverage, they can run around $35 a month and higher.

Medicare generally also doesn’t cover acupuncture, plastic surgery, or conventional foot care.

Overall, it’s important to start with your Medicare years armed so you can avoid surprises.

“Everyone’s situation is a little bit different,” says Luchene. “If you can plan ahead, you’ll be able to make sure you have the coverage you need when Medicare goes into effect.”