By Ted Stricker, CFP®
Many seniors over 65 who begin their traditional Medicare health insurance coverage might believe that they are all set with their medical coverage. Unfortunately, this is not the case. The list of what Medicare doesn’t cover is long and may surprise you.
At our firm, we often receive questions from clients about their Medicare benefits and, as we look to provide comprehensive guidance to our clients on all things financial, we believe that having a solid understanding of Medicare is essential to your retirement planning.
What Medicare Covers
First, let’s briefly discuss the expenses that are covered by Medicare. The Medicare program has several “parts,” each serving participants in a different manner. Parts A and B are known as “traditional” or Original Medicare. Part A is essentially hospital insurance and pays for in-patient care in hospitals, skilled nursing facilities (limited), surgery, hospice, and some home healthcare. Part B covers doctors’ visits, outpatient care, some preventive services and limited medical equipment or supplies. Part D is a separate plan that covers prescription drugs.
Medicare Part C (known as Medicare Advantage) is also a separate program where coverage is provided by health insurance companies that contract with Medicare. While coverage may be more extensive, Medicare C may be more restrictive in selecting your care providers, treatment, and may not cover many out-of-pocket expenses.
Essential Health Areas Not Covered
Seniors may be surprised to learn that some essential healthcare isn’t covered by Medicare.
Routine Vision Care: As eyes age and vision deteriorates, eyecare becomes a non-negotiable concern. Yet routine eye exams and corrective eyeglasses or contact lenses are not covered expenses. Separate insurance is needed to cover these costs.
Routine Dental Care: Like your eyes, teeth need attention too. Routine dental checkups, cleanings, fillings, crowns, dentures, and most tooth extractions are excluded from Medicare coverage, requiring separate insurance.
Hearing Care: Medicare doesn’t want to hear about your ears either! Hearing exams and hearing aids are excluded, requiring self-payment for these expenses.
Care Outside the United States: Seniors love to travel, but globetrotters need to purchase special medical insurance that covers emergencies and healthcare needs internationally while on their vacations or if they become ex-pats, residing in another country.
Long-Term Custodial Care: A common misperception is that Medicare covers nursing-home expenses and home care for disabled elderly patients: it doesn’t. Medicare does cover most expenses for the first 100 days if the patient is first admitted to a hospital or skilled nursing facility, but that’s it. Medicare is sometimes confused with Medicaid, which is a separate program for impoverished citizens who have little other means of paying their medical costs. Medicaid coverage for custodial or continued nursing care has strict qualification requirements before such benefits are available.
Self-Pay Is Required for Extra Services Too
Many other services that may add to your healthy lifestyle and well-being are excluded from Medicare coverage too. Surprisingly, routine physical exams are not covered by Medicare, however, women will be glad to learn that regular cervical, pelvic, and breast exams are covered as part of preventive medicine, as are exams for prostate issues and colonoscopies. Other non-essential services are not. These include:
- Chiropractic services
- Massage therapy
- Foot care
- Comfort items during hospitalization (hospital phone, TV, or a private room)
- Alternative treatments, such as acupuncture, reflexology, or other holistic therapy treatments
- Concierge care
- Nutritional therapies unless the patient has diabetes, end-stage renal disease, or kidney disease. Coverage only applies to services by a registered dietician nutritionist.
Some Medical Equipment Is Also Excluded
While Medicare B does cover many types of medically necessary equipment, other expenses that may be needed, or at least helpful, to the patient’s care are not covered either. These include:
- Home modifications, such as wheelchair ramps or stair lifts
- Motorized scooters used outside the home
- Air conditioners, bathroom grab bars, bathtub seats
- Items thrown away after use, including catheters, surgical facemasks, or compression leggings
- Routine medical items, such as bandages, gauze, etc.
- Massage devices, heating pads, or comfort cushions
As you can see, the list of what isn’t covered by Medicare is fairly extensive—and why, at Bernath + Rosenberg, we incorporate these types of details when discussing financial and retirement planning with our clients. With careful consideration and discussion, such expenses can be covered by supplemental insurance coverage or planning ahead within a thorough retirement income and expense analysis.
If You Have Questions, Speak With Us
Retirement planning is a core service we offer at Bernath + Rosenberg, and we’re here to help!
Our experienced team of Certified Public Accountants and CERTIFIED FINANCIAL PLANNER® professionals stays current with the latest in tax laws and planning strategies to help you pursue a rewarding and comfortable retirement, according to your unique and special objectives. By coordinating your retirement planning and long-term goals, we can assist you in avoiding unpleasant medical expenses late in life that could disrupt your retirement or legacy objectives.
To get started and make the most of the wealth you’ve accumulated, schedule a meeting by calling (212) 221-1140 or email tstricker@brwealth.com.
About Ted
Ted Stricker is a partner and financial advisor at Bernath + Rosenberg, a full-service accounting, tax, and wealth management firm with offices in Monsey, NY, Lakewood, NJ, Cedarhurst, NY, and Miami Beach, FL. The firm demonstrates a personalized approach to custom-tailored solutions and an unwavering commitment to client service. With over 26 years of experience in the financial services industry, Ted manages the firm’s wealth management team, and specializes in designing financial plans for business owners and affluent families. Since joining the team in 2015, he provides practical and sound advice, combining innovative approaches and solutions that reflect clients’ personality, lifestyle, and goals.
Professionals associated with Bernath & Rosenberg P.C. may be either (1) registered representatives with, and securities and advisory services offered through LPL Financial, Member FINRA/SIPC, a registered investment advisor; or (2) solely tax professionals of Bernath & Rosenberg P.C., and not affiliated with LPL Financial. Tax/accounting/CPA-related services offered through Bernath & Rosenberg P.C. is a separate legal entity and not affiliated with LPL Financial. LPL Financial does not offer tax advice or tax/accounting/CPA-related services.
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