9 Things Medicare Does Not Cover
While Original Medicare provides some security for health coverage, it doesn’t cover every service. Even for covered services, you can still have significant out-of-pocket costs. That’s why one-third of Medicare beneficiaries choose a Medicare Advantage plan. These plans expand coverage to include many services that aren’t part of Original Medicare. Here is a look at what is NOT covered by Medicare.
Original Medicare doesn’t cover acupuncture and other alternative medicine treatments. The exception is chiropractic care. However, there are very specific criteria to get chiropractic care covered. Part B—your coverage for outpatient services—will cover a manual manipulation of the spine. It must be medically necessary to correct a subluxation, and you must see a chiropractor or other qualified provider. The cost will apply to your Part B deductible. After you meet your deductible, a 20% coinsurance applies. No other services or tests a chiropractor orders are covered.
Cosmetic surgery is not a covered service under either Part A or Part B. Cosmetic surgery is closely related to another specialty, plastic or reconstructive surgery. This type of surgery improves the function or structure of a body part. Original Medicare will cover reconstructive surgery after a mastectomy for breast cancer. It will also cover surgery to correct malformed body parts or accidental injuries.
3Dentures and Most Dental Care
Medicare doesn’t cover most dental services or supplies. This includes cleanings, fillings, crowns, extractions, dentures, and other dental devices. There are very few exceptions.
The lack of dental coverage is one of the main gaps in Medicare coverage. Left untreated, oral health problems can have serious consequences for your overall health. So, you will need an ongoing option to maintain your oral health without breaking the bank. Many Medicare Advantage plans have dental benefits. You can also buy separate dental insurance or a dental discount plan.
4Eye Exams and Glasses
Routine eye exams for glasses or contacts aren’t covered services under Original Medicare. Medicare doesn’t cover the glasses or contacts either. The exception is corrective lenses for cataract surgery to implant an intraocular lens. Medicare will cover certain exams and treatments if you have diabetes or an eye disease, such as glaucoma. You can also get glaucoma tests if you are in a high-risk group. Like dental insurance, you have options to get coverage.
5Hearing Aids and Fitting Exams
Medicare doesn’t cover routine hearing exams or hearing aids, nor the exams to fit them. It will cover hearing exams if your doctor thinks you need medical treatment for a condition other than hearing loss.
Medicare Advantage plans may include this coverage. If your income qualifies you for Medicaid, it often covers hearing aids. There are also community groups that help low-income people afford hearing aids. This includes the Lions’ Club, Help America Hear, and Sertoma. Otherwise, consider getting a full hearing evaluation, and possibly hearing aids, before enrolling in Medicare.
Most long-term care isn’t medical care, it’s custodial care or personal care. It helps people with activities of daily living (ADLs), such as bathing and eating. Medicare doesn’t cover this type of care. However, it will cover some types of skilled nursing and therapy services. It will also cover hospice and end-of-life care.
If you qualify for Medicaid, it covers more long-term care services than Medicare. Otherwise, you need to consider your other options for paying for long-term care. This includes buying long-term care insurance, using your life insurance or other assets, or paying out-of-pocket.
7Outpatient Prescription Drugs
Original Medicare—Parts A and B—doesn’t cover most prescription drugs. That falls under Part D, which is voluntary. Unlike Original Medicare, you are not automatically enrolled in Part D.
If you opt for prescription drug coverage under Part D, you will buy the plan from a Medicare-approved company. Plans from these companies must meet Medicare standards for drug coverage. Most Medicare Advantage plans offer prescription drug coverage as well and must meet the same standards. There is very limited drug coverage under Part B, such as certain injectable drugs.
8Routine Foot Care
Medicare doesn’t cover routine foot care, such as removing corns or calluses. It will cover foot exams and treatment if you have nerve damage from diabetes. It will also cover medically necessary treatment for foot conditions and injuries. This includes problems like bunions and heel spurs. In addition, Medicare will cover routine foot care when you have a condition that justifies it. This includes diabetes, peripheral neuropathy, and peripheral vascular disease.
9Care Outside the United States
If you need medical care when you are outside the United States, Medicare usually won’t cover it. This includes emergency medical care. There are a few very limited exceptions.
If you are traveling out of the country, you will need coverage other than Medicare to take care of any unexpected or emergency care. Medicare Advantage plans may include this coverage. You can also find a Medigap supplemental policy that will cover you. If you don’t have either of these plans, travel insurance may be an option. Make sure the travel policy you buy includes medical care.