As an Orange County Elder Lawyer, I see many senior citizens that are concerned about what’s covered by their insurance and what they may be responsible for out of pocket. Medicare Part B is a plan that many seniors have, but it does not cover all the services they typically need. That’s why many senior citizens get “gap insurance” to offset any additional costs they may be faced with.
Here are some of the services not covered by Medicare Part B that seniors generally need to supplement with gap insurance:
Vaccinations and immunizations, such as those that are required for international travel, are not covered by Medicare Part B in most instances. The only time they’re covered is if it’s an emergency because of infection or exposure to a disease. There are two vaccine exceptions to the rule, however: flu shots and pneumonia shots are covered by Medicare Part B.
At-home prescription drugs
Any type of prescription medicine that can be taken at home without assistance are not covered by Medicare Part B. These types of prescription drugs are only covered by Medicare Part D, which is a separate coverage that requires additional payment. Medicare Part B will only cover medicines that are administered at a doctor’s office, walk-in clinic, hospital, or at home if administered by a health care professional.
Eyesight, hearing, and dental
Eye, ear, and dental exams are not covered by Medicare Part B, and neither are eyeglasses, contact lenses, or hearing aids. The only exception is if those parts of the body are affected by another illness and you are treated by a medical doctor (i.e., an ophthalmologist as opposed to an optometrist). Another exception is provided if you need contact lenses or eyeglasses that are required after cataract surgery.
Keep in mind, too, that dental coverage may vary. Dental work is covered if the procedures could be performed by a physician other than a dentist or oral surgeon. This means a typical dental exam is not covered, but a procedure involving blood vessels or nerves in the mouth or jaw would be covered.
Medicare Part B only provides for a limited amount of care in a skilled nursing facility or in a home setting. There are other options available to cover long-term care, such as long-term care insurance and services like Medicaid and VA assistance, but those services have strict eligibility requirements. In such situations, you may be able to work with an experienced elder law attorney to reallocate your assets in order to fall within Medicaid’s eligibility guidelines.
If you have any questions about Medicare Part B, or if you’d to learn more about Medicaid planning, please contact our Orange County elder law attorneys at (949) 260-1400 to schedule a consultation.