Medicare is a vital resource for millions of retirees, but understanding exactly what it covers, and what it doesn't, is key to avoiding unexpected bills. Whether you are planning for retirement or already enrolled, this guide breaks down what Medicare pays for, and what you'll need to budget for.
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Covers: Skilled Nursing Facility Care
Medicare Part A helps cover care in a skilled nursing facility after a qualifying hospital stay of at least three days. It includes room and board, skilled nursing care, rehabilitation services like physical therapy and medical supplies.
Medicare covers 100% of the first 20 days, then you pay a daily coinsurance rate through day 100. After that, you are responsible for all costs.
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Doesn't Cover: Routine Dental Care
Medicare does not cover most routine dental services, including cleanings, exams, tooth extractions, dentures, or implants unless it is part of a medically necessary procedure, such as jaw surgery.
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Covers: Preventive Care
Medicare Part B covers a wide range of preventive services designed to detect health issues early. These include annual wellness visits, cancer screenings, cardiovascular screenings, diabetes screenings, bone density test, and flue vaccines.
You are also covered for counseling on smoking cessation, nutrition, and alcohol misuse.
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Doesn't Cover: Routine Foot Care
Medicare typically doesn't cover regular podiatry visits unless you have a qualifying condition like diabetes or peripheral arterial disease that affects foot health. In this case, Medicare may cover foot exams and treatment. You'll need a doctors referral and the services must be deemed essential to treat or prevent complications.
Covers: Durable Medical Equipment
Medicare Part B covers medically necessary durable medical equipment when prescribed by your doctor. This includes wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, and blood sugar monitors.
Typically, Medicare pays 80% of the approved amount after you meet your deductible, and you're responsible for the remaining 20%. You'll need to use a supplier enrolled in Medicare for coverage to apply.
Doesn't Cover: Hearing Aids and Exams
Traditional Medicare does not cover hearing aids or routine hearing exams. If you need a hearing test solely to fit or adjust hearing aids, you'll be paying out of pocket.
However, Medicare Part B may cover diagnostic hearing exams if your doctor orders one due to a medical condition or symptoms. Some Medicare Advantage Plans (Part C) offer limited hearing benefits.
Covers: Mental Health Services
Medicare covers a variety of mental health services to support emotional and psychological well-being. Part B includes outpatient care like counseling, therapy sessions, psychiatric evaluations, and medication management. Services can be provided by psychiatrists, clinical psychologists, social workers, or therapists who accept Medicare.
Inpatient mental health treatment is also covered under Part A, though there's a lifetime limit of 190 days for care in a psychiatric hospital.
Doesn't Cover: Vision Care
Routine eye care is not covered by traditional Medicare. This includes regular eye exams, glasses, and contact lenses unless related to a specific medical condition. An exception is post-cataract surgery, in which Medicare will cover one pair of standard eyeglasses or contact lenses.
Also, exams to diagnose or treat eye diseases like glaucoma, macular degeneration, or diabetic retinopathy are covered under Part B.
Covers Home Health Care
Medicare Part A and/ or B may cover home health care if you are homebound and need skilled services. This includes nursing care, physical therapy, occupational therapy, speech-language pathology, and medical social services.
Coverage is limited to part time or intermittent care and only if a doctor certifies that you need it.
Doesn't Cover: 24/7 At-Home Care
Medicare does not cover full-time, round the clock home care. Services like live-in caregivers, personal aides for bathing or dressing, or non-medical homemaker help, such as cooking or cleaning, are considered “custodial care” and fall outside of Medicare's coverage.
Some states offer Medicaid programs that can help with these services if you meet financial and medical requirements.
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