Seven Things Medicare Still Doesn’t Pay For

by Maria

in Health Care Benefits, Medicare

Medicare will not pay for the long term care needs of your aging parent. Surprised? Many people are.

That’s because Medicare – the federal health insurance program for people over the age of 65, some disabled people under the age of 65, and anyone of any age with End Stage Renal Disease (ESRD) — is often confused with Medicaid, another health program for individuals and families with low incomes and few if any, resources.

Medicare (not Medicaid) is the coverage that your aging parent is most likely to have.  That means that each of the seven things below can only be accessed or ascertained by paying out of pocket.  This is important because your aging parent is likely to need one or even all of them at some point in the future. And trust me – they are not cheap!

What Medicare Still Doesn’t Pay For

#1: Assisted Living Facilities

I can still here it now, “What do you mean we’d have to pay out-of-pocket for an assisted living facility for my mother? I thought Medicare paid for that!” Nope.  Wish I had a nickel for every time I’ve heard this.  Are you saying this now? If so just know that you’re in some very good company.

What Medicare will fully pay for is a short-term stay in a nursing home for physical and/or occupational rehabilitation (usually 20 days). But Medicare will not ever pay for an assisted living facility.  Not even a little bit of an assisted living facility. Nothing.

Assisted living facilities are usually privately owned and operated and the cost can be prohibitively expensive.  In a major city you can expect an assisted living facility to cost upwards of $3500 per month and this is just the entry level cost. If your aging parent’s needs change additional care is available on site, but be prepared to open your wallet.

#2: Home Maker Services

Most older adults want to remain in their own homes for as long as possible.  To do so, many require assistance with tasks like making meals, keeping the home tidy and doing the laundry, for example.  These daily tasks are considered by Medicare to be “home maker services” and are not a covered benefit.

As a person ages, home maker services are often the first kind of assistance an older adult may need.  Often family members and/or neighbors step in. Perhaps a cleaning lady is hired.  However, if your aging parent needs more than occasional help with laundry or dusting and no family member can assist, the next step is often to hire private help through a home care agency.

#3: Home Health Aides

“Home health aide” is the name given to the individual who would assist your aging parent with personal care (i.e. bathing, dressing, grooming, medication reminders, etc.).  If your aging parent has mobility issues and/or is cognitively impaired, the services of a home health aide can often mean the difference between remaining at home vs. moving to a facility or nursing home.  And here again, Medicare does not cover this kind of assistance. However, there is one exception to this rule…

If your aging parent is home-bound and already receiving skilled nursing care or physical therapy, then a home health aide’s services would be covered.  Just know that there are limits to the number of hours of assistance per day and that when the skilled care ends, the home health aide will be gone.


#4:Transportation to/from doctors’ visits

It seems that getting older is almost synonymous with doctors’ appointments!  For many, getting to and from these appointments is a major challenge and can drive the need for assistance all on its own.

On the topic of transportation there are two things you should know:

  • If your aging parent is receiving some sort of treatment such as dialysis, transportation to and from the center may be covered by Medicare.
  • Many cities and counties offer low-cost transportation to seniors. To find subsidized transportation services, visit the Elder Care Locator website or call 1.800.677.1116 between 9:00 a.m and 8:00 p.m. Monday through Friday.

#5: Routine eye exams

I have to tell you, this one really gets me mad!  A condition called Age-Related Macular Degeneration (AMD) is the leading cause of blindness among older adults and routine eye care is an important part of preventing/monitoring it.

Have you heard of AMD?  It’s an eye disorder that damages the center of the retina making it tough to see fine details.  Think for a moment about how important the ability to see fine details is to living independently and you begin to get a sense of how critical routine eye exams are for older adults.  I say shame on Medicare for this one!

#6: Routine dental exams

Do you know any older adults who have dentures?  Come to think of it, a better question might be: Do you know any older adults who don’t have dentures?!  Good oral health is essential to hanging onto the teeth we have, but most experts agree that regular oral check-ups are pretty important too. As I’m sure you can imagine, dental work and/or dentures are high cost out-of-pocket expenses.  They’re also necessary to ensuring that your aging parent is able to continue eating (and enjoying) real food!

#7: Routine hearing exams

One in three people over the age of 60 and half of those over 85 have hearing loss.  For many it can have a significant impact on quality of life.  People who begin to lose their hearing may also withdraw from social situations which can increase the risk of developing depression.  An examination by an ear, nose and throat specialist (also known as a otolaryngologist) can confirm hearing loss, but Medicare won’t cover it.  Like dentures, the cost of a hearing aid (or aids!) isn’t cheap, but it can go a long way toward ensuring that your aging parent is engaged in the conversations taking place around them.

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So did you think that Medicare paid for far more than it does? If so you are not alone!  Check out the Age Well and Get Organized pages of this site for more insights on the topics discussed in this article.  You may also like:

A Short Guide to Medicare’s Parts

Five Reasons It’s Not Time for a Nursing Home

Helping Dad Say Yes to Home Care

Five Tips for Busy Family Caregivers with “Day” Jobs

The Key to Fall Prevention


Have questions about what I’ve presented here?  Let me have ‘em by getting in touch! There is no fee and no spam. :)

{ 1 comment… read it below or add one }

mark August 27, 2012 at 11:41 AM

will my medicare pay for having my teeth extracted by an oral surgeon? i need to have them out . I’m in alot of pain

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