What Medicare Doesn't Cover

What Medicare Doesn't Cover
Evan H. Farr, 4/10/2017
Medicare is our country’s health insurance program for people age 65 or older. Although the program helps with the cost of health care, it doesn’t cover all medical expenses or ANY of the cost of long-term care.
  • Hospital insurance (Part A) helps pay for inpatient care in a hospital or temporary skilled nursing facility (following a qualifying hospital stay), some minimal home health care (following a qualifying hospital stay), and hospice care (assuming your doctor has given you less than 6 months to live).
  • Medical insurance (Part B) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
  • Medicare Advantage plans (Part C) are available in many areas. People with Medicare Part C choose to receive all of their health care services through a single HMO provider.
  • Prescription drug coverage (Part D) helps pay for the costs of prescription drugs.
  • Wellness Visits: Within the first 12 months of signing on for Part B, you will get a “Welcome to Medicare” visit; afterwards, you receive “wellness” visits on an annual basis.

What Medicare Does Not Cover

Paying for home care requires planning ahead, (Paying for Care article) as you can see, Medicare doesn’t cover everything. And, even if Medicare covers a service or item, you generally would have to pay a deductible, coinsurance, and copayments. The following is a list of what Medicare DOES NOT Cover:
  • Deductibles, Co-Pays, and Patient’s Share of the Bill: There are co-pays, deductibles, and the portion of a bill that Medicare will not cover. Many consider Medicare Supplement Insurance, also known as a Medigap policy or a Medicare Supplement Insurance policies to cover these costs.
  • Medical Devices and Services: If you end up needing dental care or hearing aids, Medicare does not cover these needs under Part B, nor does Part B cover eye exams for prescription glasses, dentures, cosmetic surgery, or acupuncture.
  • Care Outside the U.S.: If you like to travel outside of the country, Medicare coverage ceases unless her Medigap policy covers her for travel.
  • Hospital care: Medicare Part A covers hospital care in a semi-private room, with meals, nursing, and drugs included–but only if you have been admitted to the hospital.
  • Home Health Services Covered in Certain Circumstances: If you become homebound, and need a walker or a wheelchair to get around, and your doctor has a “plan of care” that specifies the need for skilled nursing care delivered by a home health aid to assist with such “activities of daily living” as bathing and dressing, or part-time speech, occupational, or physical therapy, you may qualify for home health care coverage for up to 28 hours per week. In reality, most people get no more than a few hours per week of this type of care.
  • Nursing Home Care: Medicare does not pay one penny for long-term care. Medicare covers, at most, 100 days of short-term rehabilitation, and does not cover help with activities of daily living, such as eating and bathing, that the aged can need for years.

Medicaid Planning for Long-Term Care

Long-term care in our area costs $10,000 to $14,000 a month (and as you can see from this article, it is not covered by Medicare.) To protect your hard-earned assets from these catastrophic costs, you should make an appointment with an experienced elder law attorney, as soon as possible.
Evan H. Farr

Evan H. Farr

Fairfax attorney Evan Farr is a Certified Elder Law Attorney and a Member of the NAELA Council of Advanced Practitioners. Mr. Farr can be reached at 703-691-1888. If you have Elder Law questions, please send them to evanfarr@farrlawfirm.com. Virginia has no procedure for approving certifying organizations.