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The Shocking List of Services Medicare Won't Pay For

By Brian Feroldi - Apr 2, 2016 at 7:02AM

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You might be shocked to learn about some of the coverage gaps that exist in regular Medicare.

Image source: Unsplash via Pixabay.

Millions of Americans turn 65 each year, making them eligible to start receiving Medicare benefits. That's wonderful as Medicare is a great social program that helps provide seniors with a safety net in case of expensive injury or disease.

However, while the list of services it will pay for is extensive, it won't cover the cost of everything. In fact, there are a handful of very basic healthcare services that you might be shocked to find out are not covered.

If you will soon be relying on Medicare, you need to be aware of some of the gaps. Below is a list of some of the basic medical services that regular Medicare simply won't cover.

I hope you brush your teeth
One giant hole in Medicare's list of covered services is dental care. If you are looking for preventative cleaning, cavity filling, or even dentures, you'll be footing the entire bill yourself.

Image sourcre: Peggy_Marco via Pixabay.

That's a surprising truth as seniors tend to be more prone to cavities than average. The reason is because many of them have dry mouth, a common side effect of different medications. That fact can make it especially hard for them to maintain good oral health, which is troubling since diseases of the mouth not only affect your gums and teeth but are also associated with other diseases like stroke, diabetes, pneumonia, and more. That makes it especially important for seniors to be diligent about brushing and flossing regularly, but routine trips to the dentist are equally important. 

The only time Medicare will step in to help cover dental cost is during an extreme dental emergency that results in your being sent to the hospital. In that case, Medicare Part A will help to cover the cost of some dental services, but beyond that, seniors are on their own.

You better have 20/20 vision
Just like dental care, Medicare won't pay for many healthcare services related to taking care of your eyesight, either. Are you in need of an eye exam, eyeglasses, or contact lenses? If so, you'll likely have to cover the cost of the service out of your own pocket.

That's troubling as the American Optometric Association says that many adults start to experience vision problems in their mid-40s, and vision tends to get progressively worse over time. One common vision problem is presbyopia, which is when the eye loses its ability to focus. That can make it difficult to read at close distances, such as a computer screen or book.

Image source: Unsplash via Pixabay.

Presbyopia leads seniors to have to get prescription glasses to help them correct their vision problems, but in most cases, it's not something that Medicare will pay for.

Thankfully, there are a handful of exceptions to this rule that are worth noting. If you need something more serious like cataract surgery, which requires the implant of an intraocular lens, your Medicare Part B benefits will pay for corrective lenses. Also, if you have diabetes, you can have an annual eye exam to check for diabetic retinopathy. It will also cover some tests and treatments if you have been diagnosed with age-related macular degeneration by an eye doctor, but that's about it.

Can you hear me now?
The National Institutes of Health estimates that nearly 50% of adults over age 75 have some type of hearing impairment, and yet in most cases, Medicare won't cover many healthcare services related to hearing. While it will pay for some diagnostic tests if your healthcare provider believes they are necessary, you're on your own if the treatment requires a hearing aid.

Modern-day hearing aids are not cheap. According to AARP, the cost of a low-end model is $1,600 and a top-quality one will set you back $3,500, and that's just for one. Since an estimated 80% of seniors need two of them to correct their hearing issues, you are looking at a $3,200 bill at the low end.

Skipping treatment isn't a great option, either. Hearing loss can cause serious emotional and social problems. A study by the National Council on the Aging found that untreated hearing loss raises the chances of developing anxiety, paranoia, and depression and leads to a reduced participation rate in organized social activities. 

A solution for all retirees to consider
So what can seniors do about these coverage gaps?

One option is to look into buying a Medicare Advantage Plan, which can help to fill in these cracks in Medicare's coverage list. While not every plan will have a solution for each of these problems, many will help to defer some of the costs of these services. Make sure you ask in-depth questions to any company you are considering before you sign up.

There are other benefits to signing up for a Medicare Advantage Plan, too. Many plans have out-of-pocket maximums that set an upper limit of the annual expenses that you will be responsible for in any given year. That can help give seniors peace of mind if they are ever hospitalized as the bills can rack up quickly.

While there is an extra cost for enrolling in the plan, the premiums look to be quite modest. The Centers for Medicare and Medicaid Services estimates that the average premium will be $32.91 in 2016.

Given the additional benefits and relatively modest cost, it's no wonder enrollment in Medicare Advantage plans is at an all-time high. If you're searching for a plan near you, Medicare has a handy tool that can help you find one that is available in your area. 

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