I Thought Medicare Paid for That!

Caregivers are sometimes surprised by what expenses are not picked up by Medicare. Fidelity estimates that a 65-year-old couple today will spend almost $300,000 during retirement on healthcare. Read more to find out what some of the unexpected costs might be for your loved one.

If your loved one is 65 or older, he or she may use Medicare to pay for healthcare costs. Medicare is an age-based health insurance program run by the federal government and paid for by employee and employer payroll taxes. While Medicare is very much like regular health insurance, participants (and caregivers) are sometimes surprised by what is not covered in the program.

Earlier this year, Fidelity estimated that a 65-year-old couple today would spend almost $300,000 USD during their retirement to pay for healthcare costs. As a caregiver or concerned family member, it is important to know what contributes to the costs of uncovered medical expenses in retirement. Here are the most common exclusions from Medicare your loved one may encounter:

Long-term care facilities. While Medicare Part A may pay for skilled nursing under certain conditions, the coverage is short-term. Expenses for long-term care (or extended care) facilities such as independent living, assisted living, skilled nursing or memory care units are not covered by Medicare. They may be included in a long-term care insurance policy, Medicaid or possibly other programs (e.g., veterans benefits).

Vision benefits. Eye exams are not included in Medicare, nor are eyeglasses or contact lenses. However, cataract surgery is reimbursed by Medicare, Part B.

Dental services. Dental exams, procedures and supplies are not part of Medicare.

Prescription Medication. Prescribed medications are covered if your loved one signed up for Part D, which is an additional coverage option. However, even if he or she has Part D, there is something known as the “donut hole.” This is a gap in coverage, but it is not as costly as it used to be. In 2019, when your loved one’s drug costs exceed $3,820, he or she must pay an additional $5,100 before reaching the catastrophic coverage level (i.e., 100% coverage). During this “donut hole” gap period, he or she will pay 5% of the drug cost for the remainder of the year or until reaching the catastrophic level.

Alternative medicine or therapies. Medicare does not pay for homeopathic remedies, chiropractic medicine, acupuncture, massage therapy, or other types of alternative treatments.

Medical Alert Systems. If your loved one has an alert system (wearable or in their home), this is not covered by Medicare.

Medical Tourism. Medical care outside of the U.S. is not included in Medicare. This includes personal travel, having a procedure elsewhere at a lower cost or treatment that is considered experimental in the U.S. However, some supplemental policies include expenses incurred outside of the U.S.

Hospice/palliative Care. Generally, hospice care is not covered unless ordered by a doctor for a terminal illness.

Some Healthcare Providers. Healthcare providers, including physicians and specialists, can “opt out” of the Medicare program. It does not mean that your loved one can’t continue go to that particular physician. However, the service will not be paid for by Medicare and will have to be paid entirely by your loved one. This is especially important to know if your loved one is about to enroll in Medicare. If his or her current physician does not accept Medicare, a good doctor will let the patient know well before age 65, so that he or she can find a new healthcare provider, if desired.

A Final Note:

A good resource to find healthcare providers and information on Medicare coverage is at www.medicare.gov. Additionally, your loved one’s insurance provider will have information on their website as well.

The exclusions listed above apply to “original” Medicare. If your loved one has an alternative plan such as Medicare Advantage (perhaps provided by a previous employer) or some other arrangement, some of the items above may be included as part of their program. It is also important to not confuse Medicare with Medicaid. Medicaid is a means (income)-based insurance plan that can be used separate from, or in conjunction with, Medicare. What is covered under Medicaid depends on the state where your loved one lives. However, certain things, like skilled nursing, are covered by Medicaid.


Caregiver Checklist for Holiday Hospital Stays

Hospitals can be desolate places during holidays. This article provides a checklist of items for caregivers to consider.

Independence Day is next week. While not one of the major holidays like Christmas, New Year’s or Easter, it can still be…quiet…around the hallways of a hospital or extended care facility.

Where I live in the South, this is prime vacation season. The airports are busy, the commute is light, and the weather is hot! If you have the ability to do a little pre-planning before next week, here are some things to consider for your caregiving routine before the long weekend:

  • Doctor’s schedule. Will your doctor or specialist be working during the holiday or long weekend? If not, who will be covering in his or her absence? Make note of those changes.
  • Your schedule. If you are going to be out-of-town for the holiday or long weekend, do you have someone to visit and check on your loved one a few times while you are gone? When will you go over the routine, condition, doctors, special care concerns, etc. with your substitute caregiver?
  • Your contact information. Whether you are in-town or out-of-town, you may want to check in with the nursing staff at the hospital or the extended care executive director or medical director on duty during a holiday weekend. Even if you are a “regular” among the nursing staff, there may be different personnel covering a holiday weekend. It never hurts to introduce yourself or ensure that everyone has your contact information readily available if you are needed. Yes, I know it’s in the admissions records, but a gentle reminder may ease your concerns.
  • Hotel arrangements. If you live out-of-town and stay in a hotel, motel, Airbnb, etc. while your loved one is in the hospital, confirm your reservation – or make a reservation – for the holiday weekend.
  • Extra activities. Depending on your loved one’s interests, concentration and energy levels, this might be the perfect time time to bring a new book, magazine, movie or activity they can do in the hospital room. The same goes for you. You may not be able to go to the shore this weekend, but you can download the latest summer beach read that doesn’t require a lot of attention on your part or scroll through Instagram to see what people are wearing to the beach.
  • Visits/Calls/Video Chats. If your loved one is up for visits or phone calls, ask a good friend or family member to call or stop by. If you or your loved one has a phone or tablet with video-chatting capabilities, this could be a nice alternative, too. While you may be concerned about your loved one seeing others out enjoying their lives when your loved one cannot, you might be surprised at the mood booster such a “visit” can be.
  • Healthy Snacks. The hospital shops, cafeteria, etc. may be open as usual, or they may also have reduced hours. If that is the case (or if you just want to do something different or special), you can pack a lunch bag with special treats: a sandwich, string cheese, yogurt, fruit, nuts, chocolates or anything else that is easy to pack for the day.
  • Fireworks or Holiday Events at the Hospital. One year, my mother’s room was on the side of the hospital where we could actually watch the downtown Dallas fireworks. Ask around to see if there are fireworks displays close to the hospital that patients can watch. There might also be a parade on a nearby street or something going on in the hospital you and your loved one can attend (e.g., a patriotic concert by a high school choir or a community band).

For those of you who are not able to plan as far in advance, this can simply be an opportunity to be aware of the upcoming holiday and to be thinking of backup plans – especially if you, or people you rely on to relieve you for your loved one’s care, will be out of town for the long weekend.

I saw this quote for Independence Day and thought it perfectly depicted the spirit of a caregiver as well. Happy Birthday, America!

“America was not built on fear. America was built on courage, on imagination, and an unbeatable determination to do the job at hand.”

–Harry S. Truman
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