Medicare has basic coverage for hospital and medical insurance. You are covered under Part A and Part B for things like inpatient care, hospice, mental health, clinical research, preventive care, medically necessary care, and durable medical equipment. Unfortunately, Medicare does leave out some essential routine care that is especially important for seniors and maintaining their health and quality of life. These gaps include coverage for prescription drugs, dental care, vision care, and hearing care or long-term care.
Prescription Drugs
Part A and Part B only provide coverage for limited outpatient prescription drugs. These include those used with durable medical equipment, like insulin. Regular pharmacy prescription drugs are not covered by Original Medicare. Many seniors rely on daily medications to maintain their health, which is what makes prescription drug coverage so crucial.
Fortunately, Medicare Part D Prescription Drug Plans are available to solve this missing piece. These plans cover nearly all anticancer, anticonvulsant, antidepressant, antipsychotic, antiretroviral, and immunosuppressant drugs as well as other generic, brand-name, and specialty prescription drugs. You can purchase a Part D plan separately in addition to your Original Medicare.
Dental Care
Dental care is another critical component to prevent degeneration, gum disease, and inflammation which can affect your heart function and other important systems of the body. Medicare only covers medically necessary surgeries, but not routine dental procedures like cleanings, fillings, or extractions. Medicare also does not cover implants, dentures, or other equipment.
Vision Care
One of our core senses, maintaining our vision is an important task of healthcare. Regular vision exams can even help spot degeneration and links to other diseases including diabetes. Medicare does not cover routine exams, nor does it cover eyeglasses or contacts. Medicare only has coverage for eye surgery and the lenses necessary after such surgery.
Hearing Care
Another core sense, we can count on our hearing getting weaker with age. Medicare does not cover routine hearing exams, nor does it cover hearing aids or fitting appointments. It will only cover balance and hearing exams when they are ordered by a doctor to see if you need medical treatment: this coverage still leaves you with 20% of the cost.
Long-Term Care
Medicare Part A covers hospice care but does not cover custodial or long-term care. This means there is no assistance to pay for help with the activities of daily living when you or a loved one are in a nursing home or skilled nursing facility.
Other Care
Medicare also has no coverage available for routine foot care. It only covers podiatry services for nerve damage related to diabetes or surgery when medically necessary. Medicare also has no coverage for chiropractic services, acupuncture, or cosmetic surgery.
The Solution: Medicare Advantage
The primary solution to securing the routine dental, vision, and hearing care you need is to sign up for a Medicare Advantage plan. These plans have the same basic coverage as Part A and Part B but with additional packages for dental, vision, and hearing care. You can even join a Medicare Advantage plan with Part D prescription drug coverage for the ultimate combination plan.
For help finding the coverage you need, contact the Medicare experts at Jersey Medicare Solutions.
Thomas M. Brzezinski is one of the founding partners of WMAG William & Michael Advisor Group LLC and Jersey Insurance Solutions. He has been involved in the insurance industry for over ten years and specializes in developing client relationships that last a lifetime.
