Here we are again, warming up for all that Medicare is going to throw at us in 2027. Over the next few weeks, we'll try and break things down so you know what is exactly what. We'll start here.
Most people turning 65 figure Medicare is the whole enchilada. It isn't, amigo.
Original Medicare is a lot like Grandma's old quilt. Warm, sturdy, and you're glad to have it. But it's got holes, and you won't notice them until your feet get cold. Part A covers hospital stays, and Part B covers doctor visits. A few of the holes are small. A couple are big enough to swallow a retirement budget whole. Open enrollment runs October 15 through December 7, and that's your window to patch them.
Here Are The 8 That Have Real Teeth
1️⃣ Routine dental care. Original Medicare does not cover cleanings, fillings, extractions, or dentures. It covers dental services only when they are directly related to certain covered medical treatments. Options include Medicare Advantage plans with dental benefits and standalone dental insurance.
2️⃣ Hearing aids. Part B covers diagnostic hearing exams when ordered by a doctor, but it does not cover hearing aids or fittings. Over-the-counter hearing aids and Medicare Advantage hearing allowances can help reduce costs.
3️⃣ Routine vision care. Original Medicare does not cover routine eye exams, eyeglasses, or contact lenses. Exceptions include diabetic eye exams, glaucoma screenings for high-risk individuals, and one pair of glasses or contacts after cataract surgery.
4️⃣ Long-term care. Medicare covers limited skilled nursing care after a qualifying hospital stay. It does not cover custodial care, such as help with bathing, dressing, and eating. Long-term care insurance, hybrid policies, and Medicaid are potential options.
5️⃣ Care outside the United States. Original Medicare generally does not cover medical care received abroad. Some Medigap plans provide limited foreign travel emergency coverage, and travel medical insurance is also available.
6️⃣ Routine foot care. Services such as nail trimming and callus removal are not covered unless they are medically necessary due to a condition like diabetes.
7️⃣ Cosmetic surgery. You might want a little nip ' tuck, but you're on your own nickel there because cosmetic procedures are not covered. However, Medicare does cover reconstructive surgery following an accident or a mastectomy.
8️⃣ Outpatient prescription drugs. Parts A and B do not cover most prescriptions filled at a pharmacy. You will need a Part D plan or a Medicare Advantage plan with drug coverage. Additionally, a temporary program called the Medicare GLP-1 Bridge offers certain weight-loss medications to eligible Part D enrollees for $50 per month through 2027.
Before December 7
Pull out the Annual Notice of Change your plan mailed you and actually read it. If you do nothing, most plans renew you automatically into next year's version, new premium and all—and that could be a surprise you didn't want for Christmas. Then run your drugs and doctors through the Plan Finder at Medicare.gov.
Want a human to walk you through it? You've got two good choices. An independent insurance agent who specializes in Medicare won't cost you anything, because they're paid by the insurance companies. That's also the reason to ask one question up front: "How many companies do you represent in my area?" An agent who can show you plans from several carriers gives you a wider view than one who sells for a single company.
Or, if you'd rather talk to someone with nothing to sell at all, your State Health Insurance Assistance Program (SHIP) offers free, unbiased counseling. Find yours at shiphelp.org.
Here's how to use SHIP.
Conclusion
Understanding what Original Medicare does not cover is an important part of planning for retirement. By reviewing your options during open enrollment, from October 15 through December 7, you can choose coverage that fits your needs and protects your budget. Ultimately, being informed is the best way to avoid costly surprises.
