What’s Not Covered by Medicare?

Medicare Part A and Part B—also called “Original Medicare” or “Traditional Medicare”—cover a large percentage of medical expenses when you turn 65. Part A is hospital insurance that helps pay for inpatient hospital stays, stays in skilled nursing facilities, surgery, hospice care and specific home health care. Part B is medical insurance that helps to pay for doctor visits, outpatient care, some preventive services and some medical equipment and supplies. You can begin signing up for Medicare three months before the month you reach age 65.

Kiplinger’s article, “7 Things Medicare Doesn’t Cover,” takes a closer look at what isn’t covered by Medicare, plus some information about supplemental insurance policies and strategies that can help cover the additional costs, so you don’t end up with unanticipated medical bills in retirement.

Prescription Drugs. Medicare doesn’t give you any coverage for outpatient prescription drugs. However, to address this, you purchase a separate Part D prescription-drug policy that does. There are also Medicare Advantage plans that cover both medical and drug costs. Some retiree health-care policies also cover prescription drugs. You can re-enroll in Part D or Medicare Advantage coverage, when you enroll in Medicare or when you lose your other drug coverage.

Long-Term Care. Medicare gives you coverage for some skilled nursing services. However, it doesn’t include custodial care, like assistance with bathing, dressing and other daily activities. To address this, you can buy long-term-care insurance or a combination long-term-care and life insurance policy.

Deductibles and Co-Pays. Medicare Part A covers hospital stays, and Part B covers doctors’ services and outpatient care. However, you must pay the deductibles and co-payments. It is important to understand that over your lifetime, Medicare will only help pay for a total of 60 days beyond the 90-day limit, known as “lifetime reserve days.” After that, you’ll pay the full hospital cost.

Most Dental Care. Medicare doesn’t cover your routine dental visits, teeth cleanings, fillings, dentures or most tooth extractions. Some Medicare Advantage plans cover basic cleanings and x-rays, but they generally have an annual coverage cap of around $1,500. Another option is to buy a separate dental insurance policy or a dental discount plan. You can also build up money in a health savings account before enrolling in Medicare. You can use the money tax-free for medical, dental and other out-of-pocket costs at any age.

Routine Vision Care. Medicare generally doesn’t provide insurance coverage for routine eye exams or glasses. However, some Medicare Advantage plans have vision coverage. You may also be able to buy a separate supplemental policy that gives vision care alone or includes both dental and vision care.

Hearing Aids. Medicare doesn’t cover routine hearing exams or hearing aids, but some Medicare Advantage plans do cover hearing aids and fitting exams. There are also some discount programs that provide lower-cost hearing aids.

Medical Care Overseas. Medicare also doesn’t cover the medical care you get when you’re traveling outside of the U.S., except for very limited circumstances (e.g., on a cruise ship within six hours of a U.S. port). However, a Medigap plan C through G, M and N cover 80% of the cost of emergency care abroad, with a lifetime limit of $50,000. Some Medicare Advantage plans also will cover emergency care abroad.

Another option is to purchase a travel insurance policy that covers some medical expenses, while you’re outside of the U.S. This insurance may even cover emergency medical evacuation, which can otherwise cost tens of thousands of dollars to transport you aboard a medical plane or helicopter.

Reference: Kiplinger (May 23, 2019) “7 Things Medicare Doesn’t Cover”

Suggested Key Terms: Elder Law Attorney, Medicare, Medicaid, Nursing Home, Long-Term Care Planning, Retirement Planning, Elder Care

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When to Move into Senior Housing

As your loved one gets up in years, you might wonder if it is safe and practical for her to continue living in her home. Many things in modern life have a connection to a specific age, like when you can legally drive or vote. However, there is no set age for when a person should move into a senior living community. It can be hard to know when a person should consider taking this step.

The issue of when to move into senior housing is highly individual. Some people do well staying in their own homes into their nineties or even past the age of 100. Other people are eager to relocate to a development designed with them in mind, with plenty of activities and opportunities to socialize with their peers. It can be refreshing to have someone else do the lawn care and housework. Most people fall somewhere in between these two groups.

Indications that It Might be Time to Consider Senior Housing

Everyone is different, and the decision about moving into senior care should be made by your loved one, possibly with input from close friends and relatives and the senior’s health care professional. Here are a few of the signs to look for that might mean that a development for aging adults could be beneficial. Your loved one is having difficulty:

  • Preparing food,
  • Shopping for groceries and other necessities,
  • Taking his medicine as directed,
  • Maintaining a balanced, nutritious diet,
  • Walking without stumbling or falling,
  • Engaging socially and avoiding isolation, or
  • Dealing with moods and emotions, such as depression, loneliness, sadness and boredom.

If you see any of these signs, you should think about talking with your loved one about the situation. Let her know that you will offer as much help as you can, like helping her get her house ready to sell. Some people get so intimidated about the mountain of work that a move entails, they stay in place, even if they need assistance with daily living tasks.

Let your older relative know about the options available and offer to visit facilities with him. Have a few developments in mind before you have “the talk.” Set up tours at a couple of communities, then find out what he likes and dislikes about each place. Try to find a location where he will be happy and safe. A center with a wide range of care levels can provide more assistance, if he needs it over time.

Misconceptions About Senior Housing

When your aging loved one was younger, senior housing meant the nursing home or rest home. As a result, many older Americans adamantly refuse to even talk about moving into a senior living community. People would likely be more receptive to considering senior housing, if they realized that today’s facilities can include:

  • Apartments, condominiums, and attached housing units with multiple bedrooms, plenty of square footage and attractive architecture.
  • Your choice of a variety of care levels, from completely independent to not having to lift a finger, because someone else does all the cooking, cleaning and lawn maintenance.
  • Developments on golf courses, with swimming pools, tennis courts, hiking trails and many other amenities.

Be sure to talk with an elder law attorney near you about this article and any insights she or he may have.

References:

A Place for Mom. “When is the Right Time to Move?” (accessed April 14, 2019) https://www.aplaceformom.com/planning-and-advice/articles/when-is-the-right-time-to-move

Suggested Key Terms: the right time to move into assisted living, when you should move into a nursing home

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How to Pay for Assisted Living or a Nursing Home

Senior living can be costly, but with a little creativity, you can find multiple options to help you pay for this expense. You might also not need as much money as you think. Senior housing developments include some costs that you have to pay for out of pocket, while you still live in your own home.

For example, if you pay $100 a month to have your grass cut, you will most likely not have this item as a separate expense at the facility. If your monthly bill at the senior housing development includes some meals, that service will replace some of your current costs as well. Nonetheless, you will need to figure out how to pay for assisted living or a nursing home. Here are some options:

Current Income

Some people have enough money from their current income to pay for living in a senior community. For example, a person who receives $2,000 a month from Social Security, $4,000 a month from an annuity, and $1,000 a month in interest, dividends and investment income can use current income to pay for a facility that charges up to $7,000 a month.

Savings

For many people, current income is insufficient to cover the entire cost of a senior housing development. Let’s say that your current income is $3,000 a month and the assisted living center charges $5,000 a month. If you have enough savings, you can supplement your income to make up the difference. At $2,000 a month, you will have to spend $24,000 a year of your savings to live in senior housing.

Proceeds from Sale of the Home

Quite a few people plan to sell the large family home and downsize into a senior apartment or other development, when they retire. Proceeds from the sale of your home can go a long way toward helping to pay for senior housing, depending on the amount of equity in your house.

Reverse Mortgage

Reverse mortgages are not for everyone. There have been shocking scandals, in which unscrupulous lenders heartlessly took the entire nest eggs of older adults who did not understand all the terms and conditions of reverse mortgages. Be sure to check with multiple sources, like your state’s attorney general office and a trusted financial advisor who has nothing to gain from you getting a reverse mortgage, before agreeing to one of these arrangements. Read every word of all the documents and do not sign until you understand every detail.

Bridge Loan

If you find yourself in urgent need of assisted living, you might get a bridge loan to cover the costs of senior housing until your house sells. Compare the interest rate and terms of a bridge loan to a home equity line of credit.

Military Benefits

If you or your spouse served in the military, you might be eligible for Veterans Administration (VA) programs like Aid and Attendance. This program can help pay for nursing home care, assisted living, in-home care and memory care.

Long-term Care Insurance

Although fewer than three percent of Americans buy long-term care insurance, those who do can use the benefits to pay for assisted living, memory care, or a nursing home, depending on the coverage. Be sure to read the terms of the policy with great care, particularly about how long you can receive benefits and for what services.

Medicaid

After you spend down most of your assets, you might qualify for Medicaid. No organization pays for more people to live in senior housing than Medicaid does. Every state has a different Medicaid program, and each one has its own eligibility requirements. It is a good idea to talk with an elder law attorney in your area about how your state’s regulations differ from the general law of this article.

References:

A Place for Mom. “How to Finance.” (accessed April 14, 2019) https://www.aplaceformom.com/planning-and-advice/articles/financial-assistance

Suggested Key Terms: how to pay for the nursing home, how to pay for assisted living

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