Health & Wellness / Medicare

Three Important Health Services Medicare Won’t Cover

medicare

Approximately 10,000 seniors turn 65 every day and become eligible for Medicare for their health-related needs. Although Medicare covers many necessary health-related services, the fact is there are three routine services that Medicare does not cover—services that often affect a senior’s overall health and quality of life.

Some health plans for those under 65 offer some of these routine benefits for an additional premium. However, once a person enrolls in Medicare, these much-needed routine benefits are paid for 100% out of the beneficiary’s pocket without any financial assistance.

Here are the three routine services Medicare does not cover:

1. Routine dental care

Proper oral health is critical for everyone, and even more so for seniors. Research has shown that poor dental health often results in other health issues. Unfortunately, Medicare won’t pay for routine care like dental cleanings, fillings, and dentures. It also won’t cover most oral or gum surgeries. The only exception is for patients who need these exams or surgeries in conjunction with another medical procedure or issue.

That said, seniors do have options for securing dental coverage. First, you can buy dental insurance on your own.

2. Hearing aids

People generally suffer significant hearing loss as they get older. This loss of hearing ability also results in several other health-related issues due to the isolation the loss of hearing ability brings. Again, Medicare coverage comes up short in this regard, which is unfortunate, as there is a vast array of hearing-aid technologies currently available, from simple and relatively inexpensive analog circuits to complex and expensive digital devices that require sophisticated fitting procedures. The average price of a digital hearing aid is about $1500, with top-of-the-line devices costing $3000 to $5000, according to the National Institutes of Health.

3. Vision services

Routine eye exams are crucial, since untreated issues can result in permanent damage. Ailments such as glaucoma and macular degenerations, along with a host of other ailments that affect a person’s vision, are often only diagnosed during a routine exam. Additionally, a large percentage of Americans, including seniors, rely on eyeglasses or contacts to see and function. Again, Medicare doesn’t pay for either eyeglasses or vision exams, though it generally does pay for eye care treatment that is medical in nature, such as an eye injury sustained during a fall. Similarly, it does pay for certain tests or treatments related to eye disease. Also, Medicare will pay for annual eye exams for diabetic retinopathy for those who have been diagnosed with diabetes, and it covers annual glaucoma tests for those deemed to be at high risk for the disease.

For seniors, health care is often the single greatest monthly expense. Knowing what Medicare does and does not pay for will help you budget properly for that period of your life.

Options:

You can consider enrolling in one of the many Medicare Advantage plans (Medicare Part C) available. These private plans are designed to replace original Medicare (Parts A and B) but maintain all the benefits of Parts A and B and usually include prescription drug coverage (Part D). Because these Medicare Advantage plans are offered by private insurance companies, many of them offer basic hearing, vision, and dental coverage as a benefit of the plan or as an optional supplemental benefit for an additional premium, resulting in some peace of mind that a portion of the costs for hearing, vision, and dental healthcare services may be covered.

If you have any questions please call AMAC’s Medicare Department to speak to one of our Trusted, Licensed Insurance Agents

Call 1-800-334-9330 or Get Quote

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Winford Nettles
1 month ago

It sure would be nice if AMAC would give an analytical review of dental insurance and other care options available to seniors. Trying to find the right dental care for my wife in a plan that we can afford on a fixed income is a daunting task. Wish AMAC could give some guidance.

jerry
1 year ago

please call

Kathy Kraus
1 year ago

I have a Kaiser Advantage plan. I had a colonoscopy 6 years ago that was covered as preventative. I am having colitis problems and a colonoscopy has been scheduled for which I found out I have to pay $275.00. I also had to pay $128.00 for the prep kit. When I asked why the copay, she replied ‘that’s because you are having symptoms’. Really! ? Isn’t that the point of having a Medicare plan?! I’m 69 and not working at the present because of the pandemic. It couldn’t have happened at a worse time.

Debra Billinghurst
1 year ago

Just turned 65 very concerned about the reduction of care I will get through medicare would like to opt out but looks like I don’t have much of a choice here. I have worked as a n nurse for greater than 40 years. Sounds like AMAC should join forces with Citizens Council for Health Freedom.

Mary Blaylock
1 year ago

I would like some information on supplemental plans. I am a diabetic and wonder if they help with the cost of Insulin, Novalog or Lantus. The cost is very high, inflated by the makers who seem to care not a bit for the welfare of the patients who have to try to afford these products.

Jerry
1 year ago
Reply to  Mary Blaylock

Are you in Florida

Mary Blaylock
1 year ago

I was wondering how much a supplemental coverage plan would cost. I think it is a disgrace the Medicare doesn’t offer a plan that covers dental, hearing and eye care. I have issues in all three areas, especially hearing. I am a diabetic and could sure use some help in covering the cost of insulin. I use Novalog and Lantus and they are very expensive. I have been waiting for a return call all day and wondered if any one was going to call before the end of the day. I realize you are very busy, but I am important also. Sincerely, Mary Blaylock, 805 967-8186

oldbat
1 year ago
Reply to  Mary Blaylock

mary, never put your phone number in a public place like this.

Joan
1 year ago

With my dentist, there is only one (1) plan in which he participates, and it is not a part of any Medicare Advantage program. It is independent. So, the best thing to do, if you like your dentist, ask what plans the office accepts. Google those plans and find out how you can join. I have Delta Dental, which has stand alone plans, so don’t let AARP make you think you have to have their version of it. It has several plans, but my DDS only participates in one of them, so verify before signing on the dotted line. Because I want this dentist, and am willing to keep my policy, I like the flexibility the Supplemental policies offer, and am not paying for extra dental coverage in an Advantage plan, which I will never use.

w. knight
1 year ago

I will NOT provide my phone number for this information to make a purchase from you. If l cant not get the info get plan elsewhere and will consider cancelling my membershipw.knight

oldbat
1 year ago
Reply to  w. knight

just use all 0

Barry
2 years ago

Except for plans listed by my area (Aspire and Medicare Advantage F) nothing else is available. Looking for a Dental or Vision savings plan. Aspire has one but looking for better coverage.

Lynda McNary
2 years ago

Does AMAC have an insurance that covers Chiropractic or acupuncture treatments?

Timothy C.
2 years ago

My Medicare Advantage covers all three!

Maureen B.
2 years ago
Reply to  Timothy C.

Hi Timothy, which Medicare Advantage do you have? I am currently on Medicare and supplemented by United healthcare, and need Dental and vision coverage too. I just joined AMAC and would like to switch over but need to make sure I get the right coverage. Thank you.

Paul
2 years ago

ABOLISH medicare irs and every government program….i thought we were conservatives that want LESS government. Medicare taxes collected during your life time of work average $150K while medical expenses per medicare recipient is 350K -yes a 200K deficit per person

Susan Wilson
2 years ago
Reply to  Paul

Yes, the expense amounts to more, but the collected amount over the years as in SS, was supposed to be invested to grow and cover the overall expense. Instead, they took it added it to the govt budget and spent it, eliminating the growth expectations. So, no, we aren’t doing well in the Medicare realm. Bad govt decisions should be addressed by those in charge and the snakes held responsible. Start with LBJ who signed the bill allowing our ss to be used.

L. Mapleaf
2 years ago

And yet the bums on MedicAID get complete coverage including dermo for acne and orthodonture…why is that?

Vena
1 year ago
Reply to  L. Mapleaf

We pay for their care…that’s a Godly way. BUT!!! I don’t get it either. I think ALL SENIORS should be Free too. Worked all our lives to take care of others, now on a fix income we still taking care of others.

Vickie
2 years ago

True, Medicare does not cover ROUTINE eye exams. BUT, they do cover your eye exams if you have a medical diagnosis such as cataracts, glaucoma and macular degeneration. AND, everyone age 65 or older does have either cataracts or has had cataract surgery (Most people develop cataracts between the ages of 40 and 60). However, if you are diagnosed with cataracts but they are not ready for surgery and glasses will help you see more clearly, Medicare does not cover the refraction (where the exam for determining the glasses Rx is determined) so you would have to pay for that as well as the cost of glasses out of pocket. And, if you purchase a plan that covers routine eye exams and glasses and then something like glaucoma or macular degeneration is diagnosed, your routine plan does not cover medical problems and you would have to schedule another appointment for an evaluation of whatever medical diagnosis you were given. I work for an ophthalmology practice and see this on a daily basis.

Dan W.
2 years ago
Reply to  Vickie

Good information Vickie.

One additional point, make sure that your eye care provider accepts assignment from Medicare in order to get reimbursed for the glaucoma and macular degeneration testing portion of your eye exam.

While many ophthalmologists do accept assignment from Medicare, many optometrists do not so be sure to ask your provider if they accept assignment from Medicare for these tests when scheduling your next appointment.

Rene A. Gowin
2 years ago

Sad because those three things are what every senior needs, we no longer need birth control or Vigra we need teeth hearing laughter and seeing our grand children.

Vena
1 year ago
Reply to  Rene A. Gowin

Hahaha yea u r right lol

Lindsey
2 years ago

I have a Medicare supplement, which really only pays what Medicare doesn’t. It doesn’t “supplement” additional things like dental care, vision, or hearing, which I believe it should. While having the supplement has been very helpful to me over the past year or so, I also pay a price for that supplement. I believe a supplement should SUPPLEMENT, not just pick up what’s left over.

Ed D
2 years ago
Reply to  Lindsey

Let the free market rule If a supplement doesn’t fulfill your needs, shop around for one that will. Plus there are stand alone dental plans. AMAC has info on these plans,

ted ball
1 year ago
Reply to  Lindsey

A supplement only supplements your existing insurance, in this case Medicare. So by definition supplemental insurance cannot possibly supplement a benefit that does not exist in the first place. This never happened until Obama so his painful legacy lives on

John
1 year ago
Reply to  Lindsey

Buy vision, and Dental care! Supplements are much better than ANY ADVANTAGE program. ALL ADVANTAGE programs have back end deductibles. Keep your silver sneakers………. I am happy with peace of mind….NO BILLS. The most prominent factor of bankruptcy today is HEALTH CARE costs! When your on a fixed income you should protect your home and spouse from the medical bills.

Suzette Becker
2 years ago

It’s a sin that they don’t provide thes in Medicare!!!!
Other countries do.

Ed D
2 years ago
Reply to  Suzette Becker

Then move to these countries and expect to pay higher taxes to support their healthcare.

Ralph Ormsbee
2 years ago

We just need to Fix Social Security and Medicare. You should have a movement on it. The Fix is that all of Congress,House and Senate can only Retire on Social Security and any public Job they may have put their time into as well as all federal and local Government Personal.

JGS
2 years ago
Reply to  Ralph Ormsbee

Agree. If all members of Congress and their families had to put up with what the common retired family has to deal with, it would get fixed.

Also suggest term limits for both the House and the Senate.

Additional to term limits, do not allow them to get full retirement benefits after only several months of work. Only grant that if they serve to the end of their term limits. If not, prorate their retirement benefits accordingly.

Last: When they refuse to submit their required job tasks, reduce their monthly pay and pay of their staff and allowed expenses proportionally for every day they they don’t get their work done. Elected congressional representatives are our employees and should suffer the consequences when they don’t perform. No excuses.

Deb
2 years ago
Reply to  Ralph Ormsbee

They’d have to pay into Social Security which they don’t do now.

Peg T
2 years ago

I have never learned how 2 acquire an HSA. Some years one can have less expenses than others. Having an HSA would serve as a self insured back up plan. At 89, my major expenses are eyes, dental & hearing. I have paid out an avg. of $5000 per yr but very little was ever used for the 3 mentioned in this article.

Dan W.
2 years ago
Reply to  Peg T

A Health Savings Account (HSA) is a tax-advantaged account created for individuals who are covered under high-deductible health plans (HDHPs) to save for medical expenses that HDHPs do not cover.

A high-deductible health insurance plan (HDHP) is an insurance plan that has a higher annual deductible than typical health plans, with a minimum and maximum deductible of $1,350 and $6,750 (as of 2019), respectively, for individuals.

To qualify for an HSA, the taxpayer must be eligible, as per standards set out by the Internal Revenue Service (IRS). An eligible individual is one who has a qualified HDHP, has no other health coverage, is not enrolled in Medicare and is not a dependent on someone else’s tax return.

Carla Sims
2 years ago

Please stop misleading people about Medicare Advantage plans. They do not work like traditional medicare. They require preauthorization for many things. For example, if you break a hip and need inpatient rehab, you’re probably not going to get an approval. So sad that people arent getting services they need. I see it everyday, so please stop lying to our seniors!!!!

Aiyuna
2 years ago
Reply to  Carla Sims

Carla, I guess it depends on WHICH Medicare Advantage plan you have. Mine DOES cover those services: I just had a hip replacement, and had home physical therapy for 2 weeks, and the option (which I declined) to have out-patient therapy, too.

Deacon John Berstecher
1 year ago
Reply to  Aiyuna

Yes, I have a Advantage plan also, with no extra premium, and saves me about $400/month on prescriptions, as they cover 90 day supply a zero cost. NO, not all plans are the same, and you need to check them.
HINT: These plans MUST cover at least what Medicare A & B do. That can add to it, but not takeaway.

mike thompson
2 years ago
Reply to  Carla Sims

My Hospital flat out told me if I have a Medicare Advantage plan it won’t continue paying the same as the original Medicare A and B paid out. So you got to be careful I’m thinking of just switching over until all the dental work is done and then switching back to the original Medicare Plan A & B

Colleen
1 year ago
Reply to  mike thompson

I believe once you choose an Advantage Plan, you can’t switch back.

Herb
2 years ago
Reply to  Carla Sims

We have had Medicare Advantage for 22 years and it has done very well for us. Zero premiums.
Cataracts, knee replacements and others.

Annette
1 year ago
Reply to  Herb

Please, tell me the name of your Medicare Advantage plan. My husband and I are trying to make an informed decision and it is all a bit overwhelming. Thank you for any information that you can share.

Linda H Landen
1 year ago
Reply to  Annette

Yes! I would like to know also!

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