Jesse Smedley
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
Medicare is not all it’s cracked up to be. There are a few really big gaps in Original Medicare, benefits that you may assume are included and have likely been included in plans offered by your employer.
That doesn’t mean it’s not good insurance. It is. But you need to know what benefits are not covered so that you don’t wind up with big bills.
Dental Insurance
Dental benefits are not covered at all by Medicare. Most dentists and many medical professionals recognize the importance of proper oral hygiene to your health. Actually a recent study found a staggering correlation between patients not brushing their teeth and hospital acquired pneumonia.
That being said, Medicare offers no dental benefits. You will need a stand alone dental plan or a Medicare Advantage plan that offers dental coverage. Make sure to pay close attention to:
- Networks (DHMO vs PPO)
- Waiting Periods
- Out of Pocket Limits
Hearing
One in three people older than age 60 have hearing loss, and one in two people older than age 85 have hearing loss.
And yet, this is still not covered by Medicare.
Hearing loss that goes untreated can lead to social isolation and also has been linked to dementia.
Without insurance, an audiologist fitted prescription hearing aid can be well thousands of dollars. But recently hearing aids have become available over the counter for a few hundred instead. They are usually programmed via cell phone.
Now, if you do need more specific care under the guidance of a doctor, there are some plans that may be able to provide coverage. But they are rather limited.
Vision
Vision is also not covered by Medicare, or at least glasses and contact lenses.
However, it would cover
Again, many Medicare Advantage plans do offer vision coverage, but proceed with caution. You can also purchase stand alone plans rather inexpensive to cover your prescription glasses.
These plans are usually somewhere between $5 to $30 per month, so if you wear glasses, it’s definitely worth it!
Routine Physical
A routine physical is not covered by Medicare…What?
In a way, this comes down to minute details and possibly medical. You need to be the expert and be your own advocate because a recent study indicated that somewhere around 80% of medical bills had some type of error- often due to medical coding errors.
So, there are a few different types of “regular” doctor’s visits according to Medicare:
Make sure you plan your visits appropriately so you don’t get charged. And if you do receive a bill, make sure they charged Medicare for the correct type of doctor’s visit.
Long Term Care
Long term care is not covered by Medicare. This is a common misconception because Medicare does cover nursing home care and skilled nursing facility care. However, these are not the same as long term care.
When you think of a nursing home, you may be thinking of a senior living facility or assisted living facility and Medicare does not cover this.
Skilled nursing facility or nursing in home care is meant to provide rehabilitative or habilitative care after a hospitalization due to illness or injury. Long term conditions such as dementia would disqualify you.
Long term care is meant to assist with ADLs or activities of daily living. Things like:
- Dressing
- Bathing
- Transferring
- Walking
- Toileting
- Eating
- Continence
