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Medicare provides essential health coverage for millions of Americans, but many people are surprised to learn that it doesn’t cover everything. Gaps in Medicare coverage can leave beneficiaries responsible for significant out-of-pocket costs. Understanding what Medicare doesn’t cover—and how to protect yourself financially—can help you make informed decisions about your healthcare. What Medicare Doesn't Cover While Medicare Parts A and B (Original Medicare) cover hospital stays, doctor visits, and certain medical services, they do not include several important healthcare expenses: 1. Dental, Vision, and Hearing Care Medicare does not cover routine dental exams, cleanings, fillings, dentures, eyeglasses, or hearing aids. These services are essential for maintaining overall health, yet they can be costly without supplemental insurance. 2. Long-Term Care If you need help with daily activities such as bathing, dressing, or eating, Medicare won’t cover extended stays in a nursing home or assisted living facility. Medicaid may help those who qualify financially, but most individuals will need other planning strategies. 3. Prescription Drugs Original Medicare does not cover most prescription medications. Beneficiaries must enroll in a Medicare Part D plan or choose a Medicare Advantage plan that includes drug coverage to help with these costs. 4. Overseas Medical Care If you travel outside the U.S., Medicare typically won’t cover your healthcare expenses. Without supplemental insurance, you could face high medical bills if you need care while abroad. 5. Alternative and Cosmetic Treatments Medicare does not cover acupuncture (except for certain cases of chronic pain), chiropractic care beyond spinal adjustments, or elective cosmetic procedures. How to Fill the Gaps in Medicare Coverage Fortunately, there are several ways to protect yourself from the costs Medicare doesn’t cover: 1. Medicare Supplement Plans (Medigap) Medigap policies help pay for expenses such as copayments, deductibles, and coinsurance. These plans, offered by private insurers, can reduce your out-of-pocket costs and provide peace of mind. L earn more about Medicare Supplement Plans → 2. Medicare Advantage Plans Many Medicare Advantage (Part C) plans include additional benefits such as dental, vision, hearing, and even wellness programs. These plans are a great alternative to Original Medicare, offering broader coverage under a single policy. Medicare Part D provides prescription drug coverage and is sold by private insurance companies. Most Medicare enrollees purchase prescription drug coverage as an addition to their Medicare coverage. Learn more about Medicare Advantage (Part C) → 3. Standalone Dental, Vision, and Hearing Insurance Since Medicare doesn’t cover routine dental, vision, or hearing care, separate insurance policies can help cover these essential services. 4. Long-Term Care Insurance Long-term care insurance can help cover the costs of assisted living, nursing homes, and in-home care, reducing the financial burden on families. 5. Travel Insurance with Medical Coverage If you travel frequently, investing in a travel insurance plan that includes emergency medical coverage can provide peace of mind. Get Expert Guidance on Medicare Coverage Navigating Medicare’s complexities can be overwhelming, but you don’t have to do it alone. At Senior Insurance Advisors, we help individuals understand their Medicare options and find the best supplemental coverage to meet their needs. Contact us today to ensure you have the protection and benefits you need for a secure and healthy future!
How does Tricare and VA work with Medicare? Service members who leave active duty may qualify for health care coverage through either the Department of Veterans Affairs (VA) or TRICARE, depending on how they separated from the military. But what happens to your VA or TRICARE benefits when you turn 65, which is the age most people become eligible for Medicare ? Do veterans and military retirees have to take Medicare Part A and Medicare Part B , or do the VA and TRICARE provide enough coverage? It’s all about what works for you. Medicare can add another layer of coverage, protection, cost savings, and convenience if you already have VA benefits or TRICARE. Here’s how. VA benefits and Medicare enrollment You can be enrolled in benefits through Veterans Affairs (VA) and Medicare at the same time. Having both gives you more options for care, as well as the flexibility and freedom to choose providers within the VA or with a non-VA provider in your Medicare network. Plus, Medicare Advantage plans can come with extra benefits that most veterans don’t receive through the VA, such as dental, vision, gym memberships, over-the-counter allowances and transportation benefits. How Medicare and VA benefits work together Although you can have benefits through Veterans Affairs (VA) and Medicare, you’ll need to choose which benefits you want to use when receiving care: To use your VA benefits, you must visit a VA doctor or VA medical facility. The VA may also cover care at a non-VA facility if it’s preauthorized. To use your Medicare benefits, you must receive care at a Medicare-authorized facility. In some cases, Medicare may also be able to pay for services the VA has not authorized. What Medicare does and doesn’t cover will depend on your plan, where you’re receiving care, and which benefits you plan to use — if you can use both. TRICARE and Medicare enrollment As a veteran, your coverage under TRICARE ends once you become eligible for Medicare. That means you’ll need to enroll in Medicare Parts A and B during your Initial Enrollment Period to avoid any lapse in TRICARE coverage. When you enroll in Medicare Parts A and B, TRICARE will automatically switch to TRICARE For Life (TFL). TFL acts as supplemental coverage for your Medicare plan. That means Medicare is your primary payer, while TFL reduces or eliminates out-of-pocket costs for deductibles, coinsurance, and copayments. How Medicare and TRICARE work together When you have Medicare and TRICARE For Life, you can visit any authorized provider. Here’s how the two work together to pay your health care costs: The provider will file the claim(s) with Medicare. Medicare will then pay the portion it’s responsible for and send the claim to the TRICARE For Life. TRICARE For Life will pay its portion directly to the provider for the services TRICARE covers. There are so many factors to consider when choosing the Medicare coverage that is right for you, and it can be an overwhelming process. We would love for you to schedule a free consultation to go over your unique needs. We want to empower you to choose the coverage that is the best for you. Ready to enroll now? Click here to enroll and enter your zip code to get started!
