If you're looking forward to getting Medicare because you think this health insurance for seniors will provide comprehensive coverage, you may end up disappointed. Studies have shown seniors with high-prescription drug needs could incur as much as $350,000 in out-of-pocket spending on healthcare during retirement, even with both Medicare and a supplementary Medigap policy.
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You need to be as prepared as you can for high healthcare costs as a senior, and that starts with understanding the kinds of healthcare services that Medicare won't pick up the tab for. Here are seven you should be aware of.
1. Chiropractic care and most alternative treatments
Even though about half of all older adults experience some degree of back pain, Medicare won't cover chiropractic care or acupuncture to help manage or eliminate discomfort.
While Medicare will cover spinal manipulation when necessary to correct a misalignment in the spine (called a subluxation), routine chiropractic care to stay healthy -- which is called maintenance care -- is not paid for. Acupuncture and many other alternative and holistic treatments are also not covered at all.
To try to get your chiropractic costs covered, make sure your doctor knows of any discomfort or symptoms of pain you've been experiencing, as care for an acute condition can be paid for through Medicare. Ask your alternative care practitioner up front how much a procedure will cost and how much insurance may cover -- and before you undergo an alternative treatment in the first place, make sure there are clinical studies attesting to its efficacy.
2. Home health aides/personal care
If you become unable to perform the routine activities of daily living, like showering or eating meals on your own, you may require a personal care aide to come to your home and assist you. Medicare will pay for certain types of home care, including occupational therapy, intermittent skilled nursing care, physical therapy and speech therapy services -- as long as your doctor certifies that you need the care as part of a planned course of treatment, and as long as leaving your home is difficult for you.
If you need more than intermittent care, or if you need unskilled care -- e.g., help with hygiene, as opposed to physical therapy or injections -- Medicare will not pay for you to receive this type of care in your home. You can purchase long-term care insurance to cover the costs of home health aides, but the premiums can be high, the amount of coverage may be too low, and you may have a long waiting period before the insurer begins to pay for the costs of care.
Medicaid will pay for long-term care services for eligible seniors who need more than just intermittent help and who need unskilled services, but in order to qualify for Medicaid, your income and assets must fall below your state's eligibility threshold. Some seniors work with Medicaid planning attorneys to structure the ownership of their wealth in such a way that their assets do not count as resources that would disqualify them from Medicaid coverage. This may be the best way to preserve your wealth and still get long-term care at home if you need it.
Another option is to self-insure -- i.e, to pay for long-term care out of your own savings. This is a viable option if you're confident you can pay for a few hundred thousand dollars' worth of long-term care. If you aren't, you may want to explore one of the alternatives above.
3. Nursing home care
Like long-term care, nursing home care for eligible seniors can be covered by Medicaid, while Medicare pays only for a brief stay in a skilled nursing facility. You should take the same approach to paying for nursing home care as you would to paying for long-term care. Look into a comprehensive long-term care policy if you can afford it, or make plans to qualify for Medicaid coverage when you need it.
The Veterans' Administration may also provide some help covering costs of long-term care and nursing home care for eligible veterans and their family members. Aid & Attendance benefits, for example, are an increase in pension funds for veterans who require care in a nursing home setting or who have functional limitations that leave them unable to do everyday tasks.
4. Dental care
Medicare does not cover dental services except in limited circumstances, like when you must go to a hospital for a complicated procedure or emergency surgery. You can purchase a Medicare Advantage or Medigap plan to get supplementary coverage for dental care, and this supplementary plan may also cover other costs as well. You can also talk with your doctor about cash discounts or seek care from a dental school if one is located near you.
5. Vision care
Medicare does not cover routine eye exams, eyeglasses, or contact lenses. Cataract surgery and certain other procedures for the eyes, including emergency procedures, can be covered by Medicare. However, if you just need a routine exam or an updated pair of glasses, you'll have to pay out of pocket.
Many Medicare Advantage plans also include vision coverage. Otherwise, online sources like Zenni Optical offer glasses as inexpensive as $6.95 plus $4.95 shipping, and discount eye exams are available at big box stores, including most Walmart and Sam's Club stores.
6. Hearing care
Diagnostic hearing tests are covered only if your healthcare provider orders a hearing and balance exam to determine whether you need medical care. Hearing exams and hearing aids are not paid for by Medicare. Purchasing a hearing aid or buying a hearing aid online could save you thousands of dollars, as could shopping at wholesale stores like Costco. Some Medicare Advantage or Medigap plans will also provide at least partial coverage for hearing exams and hearing aides.
7. Routine foot care
Although Medicare Part B will pay for a podiatrist to treat foot injuries and diseases such as heel spurs or bunions, you're on your own for routine care like nail clippings, removal of corns or calluses, and preventive maintenance. To save on care costs, consider telemedicine services, or shop around for low-priced care by calling podiatrists in your area. Make sure your doctor knows all that symptoms you're experiencing so your doctor can determine whether you have foot problems that are covered.
By working with your caregiver -- not just for foot care but for all the types of care that are not covered -- you can find ways to keep your costs down even for services you have to pay for yourself. Working with a caregiver to lower healthcare costs should help your retirement savings last longer.
