Where Medicare Falls Short

Get wise about maintaining your health – and wealth – in retirement. Medicare provides a lot of coverage, but it doesn’t cover everything.

You may have a clear vision of your ideal retirement, but that dream could be challenged by unexpected healthcare costs. Even with Medicare, quality healthcare can come with a hefty price tag. There are still premiums, copayments, deductibles and other out-of-pocket expenses that must be accounted for.

To better estimate and plan for your future medical costs, take a look at what Medicare may not cover.

Hearing and vision

Hearing aids can range from $900 to more than $6,000 each, depending on the technology. They also need to be replaced every five years or so and require maintenance and batteries. Medicare covers hearing tests when medically necessary (think vertigo or injury), but otherwise you’re on your own. A typical hearing test can cost up to $250 without insurance; it’s about the same cost for a hearing aid fitting or consultation, too.

Traditional Medicare also doesn’t usually cover the cost of glasses, contact lenses, or eye exams, though there are some exceptions for those who have had cataract surgery.

Dental care

Routine dental care, including dentures, is not covered by Medicare or supplemental health insurance. The American Dental Association estimated that the average cost of two exams and cleanings and a set of X-rays is about $288. It’s estimated that an average retired couple will spend $18,590 out of pocket for dental services without additional insurance.

Mental health

Many retirees struggle with finding a sense of purpose when they transition into retirement, and this can lead to anxiety, stress or depression. Unfortunately, Medicare may not provide enough support. Part B allows for an annual health screening and therapy should you receive an official diagnosis. Medicare covers 80% of the cost after you meet your deductible; you’ll be responsible for the other 20%, which can range from $50 to $250 an hour with an approved provider.

Coverage abroad

Like to travel overseas? You might be under-covered. Traditional Medicare generally does not provide coverage for hospital or medical costs outside the United States. Residents of Puerto Rico, Guam, the U.S. Virgin Islands, American Samoa and the Northern Mariana Islands are covered, and in some cases, inpatient hospital services in Canada or Mexico may also be covered.

If your wanderlust takes you further abroad, consider short-term travel insurance or a Medigap policy that covers foreign emergencies, such as plans C through J. Just be aware that the coverage applies for a limited time and doesn’t cover all expenses. A deductible and lifetime maximum apply.

Long-term care

Medicare, for the most part, doesn’t cover long-term or custodial care for help with everyday tasks like dressing or bathing. However, some 70% of us will need some form of long-term care either in a specialized facility or at home. The median cost of nursing home care in 2020 was $93,075 – even higher for a private room – according to the Genworth Cost of Care survey, and the median cost of a home health aide was $150 a day. Long-term care insurance can help you manage this risk by covering a range of nursing, social and rehabilitative services for people who need ongoing assistance due to a chronic illness or disability. Talk to your advisor about when it makes sense to invest in a policy, what coverage you might need for skilled, intermediate and custodial care, and whether it makes sense to pay your LTC premiums from a health savings account (HSA). Of course, supplemental insurance might help in many cases, but even that comes at a cost, and the premiums are subject to inflation over time.

Covering your bases

You have several options when it comes to planning for the expenses mentioned above. A broad approach may be allocating a lump sum of money to cover the average lifetime healthcare costs. However, not everyone is able to set aside hundreds of thousands of dollars to fund future healthcare needs. Even if you can, it may take away from your general retirement savings, leaving you with a smaller pool of assets to fund the lifestyle you’ve worked so hard for.

It may be more practical to estimate your and your spouse’s projected health needs based on your family history and state of health. You and your advisor can start with a baseline for a person your age and adjust from there depending on how conservative you wish to be. Keep in mind, the longer you expect to live, the higher your costs could be, so you may want to use more aggressive numbers in your estimations.

You may also consider a hybrid approach, estimating costs, buying enough insurance to cover most of your anticipated needs and then setting aside a smaller cash reserve for the unexpected.

It may be advantageous to use a health savings account (HSA) while you can. HSAs are associated with high-deductible health insurance plans, and the money saved within them can be used for many of the costs outlined above as well as other qualifying health expenses. Distributions for qualified medical expenses are also tax-exempt. You can’t contribute once enrolled in Medicare, even if you’re still working – but you can use any HSA funds you already have and roll over unused amounts.

Think through, too, how life insurance could play a role. Most permanent life insurance policies allow partial withdrawals or loans for healthcare expenses. The caveat here is that any unpaid loan amounts will reduce the future benefit to your heirs.

If you’re still working, you may be covered by an employer-sponsored plan, but you’ll need to determine how your benefits work with Medicare and what your spouse may be entitled to. Some previous employers also extend insurance benefits to retirees.

To your health

It pays to understand what you can and can’t expect from Medicare so that unexpected medical expenses don’t eat into your retirement savings. Rely on your financial advisor to help clarify issues, add in contingency plans to your retirement income strategy and point you toward helpful resources.

Sources: Centers for Medicare & Medicaid Services; medicare.gov; aarp.com; time.com/money; kiplinger.com; "How Much Does Therapy or Counseling Cost?" Depression RSS2, March 29, 2016; costhelper.com

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