10 Things Medicare May Not Cover
I will be enrolling in Medicare in a few months and would like to find out what they do not cover so I can avoid any surprises.
While Medicare (Part A and B) covers a wide array of health care services after you turn 65, it does not cover everything. If you need or want certain services that are not covered, you will have to pay for them. Some additional benefits may be available to you if you have other insurance or if you enroll in a Medicare Advantage health plan. Here is a look at some common medical services that original Medicare may not pay for.
Most dental care: Routine dental care including checkups, cleanings, fillings, tooth extractions and dentures may not be covered by Medicare. However, some Medicare Advantage plans cover basic dental care services.
Routine vision care and eyeglasses: Medicare does not cover routine eye exams, eyeglasses and contact lenses (except following cataract surgery). However, some tests, treatments and surgeries for medical eye diseases like cataracts, glaucoma and macular degeneration are covered. Some Medicare Advantage plans offer routine vision benefits.
Alternative medicine: Acupuncture, chiropractic services (except to fix subluxation of the spine) and other types of alternative or complementary care may not be covered by Medicare.
Prescription drugs: Medicare (Part A and B) does not provide coverage for outpatient prescription drugs. You can buy a separate Part D prescription drug policy that may provide coverage. A Medicare Advantage plan covers both medical and drug costs.
Cosmetic surgery: Most cosmetic procedures are not covered, however, if the surgery is due to an injury or deformity, it may be covered. For example, Medicare will cover a breast prosthesis for breast cancer survivors.
Hearing aids: Medicare will not pay for hearing exams or hearing aids. It may cover a hearing and balance exam, if your doctor determines it is necessary. Some Medicare Advantage plans offer hearing benefits.
Long-term care: Nursing home care and assisted living facilities are not covered by Medicare. Medicare will help pay up to 100 days of skilled nursing or rehabilitation care immediately following a hospital stay of three or more days.
Personal home care: If you need to hire help for bathing, dressing or getting out of bed, Medicare typically will not cover these costs. In some cases, such as if you are homebound and are also receiving skilled nursing care, Medicare may provider coverage. Housekeeping services, such as shopping, meal preparation and cleaning may not be covered, unless you are receiving hospice care. A few Medicare Advantage plans offer in-home support services.
Routine foot care: Medicare does not cover most routine foot care, like the cutting or removing of corns, calluses and toenails. But Medicare may cover medically necessary podiatrist services for foot problems like hammertoes, bunion and heel spurs. Exams, treatments and therapeutic shoes or inserts may be covered if you have foot problems due to diabetes.
Overseas coverage: In most cases, health care outside of the United States is not covered by Medicare except for very limited circumstances – such as on a cruise ship within six hours of a U.S. port. Medigap supplemental plans D, G, M and N cover 80 percent of emergency care abroad. Some Medicare Advantage plans cover emergency care abroad.
The best way to find out what Medicare covers is to talk to your health care provider. Visit Medicare.gov/coverage and type in your test, item or service or download the Medicare “What’s covered” app on the Apple App Store or Google Play. To look for Medicare Advantage plans that offer additional benefits visit Medicare.gov/plan-compare.
Keep in mind that even if Medicare covers a service or item, it may not pay 100% of the cost. You will have to pay a monthly Part B premium (which is $144.60 for most beneficiaries in 2020) and unless you have supplemental insurance, you will have to pay your annual deductibles and copayments too. However, most preventive services are entirely covered by Medicare without copays or deductibles.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
While Medicare (Part A and B) covers a wide array of health care services after you turn 65, it does not cover everything. If you need or want certain services that are not covered, you will have to pay for them. Some additional benefits may be available to you if you have other insurance or if you enroll in a Medicare Advantage health plan. Here is a look at some common medical services that original Medicare may not pay for.
Most dental care: Routine dental care including checkups, cleanings, fillings, tooth extractions and dentures may not be covered by Medicare. However, some Medicare Advantage plans cover basic dental care services.
Routine vision care and eyeglasses: Medicare does not cover routine eye exams, eyeglasses and contact lenses (except following cataract surgery). However, some tests, treatments and surgeries for medical eye diseases like cataracts, glaucoma and macular degeneration are covered. Some Medicare Advantage plans offer routine vision benefits.
Alternative medicine: Acupuncture, chiropractic services (except to fix subluxation of the spine) and other types of alternative or complementary care may not be covered by Medicare.
Prescription drugs: Medicare (Part A and B) does not provide coverage for outpatient prescription drugs. You can buy a separate Part D prescription drug policy that may provide coverage. A Medicare Advantage plan covers both medical and drug costs.
Cosmetic surgery: Most cosmetic procedures are not covered, however, if the surgery is due to an injury or deformity, it may be covered. For example, Medicare will cover a breast prosthesis for breast cancer survivors.
Hearing aids: Medicare will not pay for hearing exams or hearing aids. It may cover a hearing and balance exam, if your doctor determines it is necessary. Some Medicare Advantage plans offer hearing benefits.
Long-term care: Nursing home care and assisted living facilities are not covered by Medicare. Medicare will help pay up to 100 days of skilled nursing or rehabilitation care immediately following a hospital stay of three or more days.
Personal home care: If you need to hire help for bathing, dressing or getting out of bed, Medicare typically will not cover these costs. In some cases, such as if you are homebound and are also receiving skilled nursing care, Medicare may provider coverage. Housekeeping services, such as shopping, meal preparation and cleaning may not be covered, unless you are receiving hospice care. A few Medicare Advantage plans offer in-home support services.
Routine foot care: Medicare does not cover most routine foot care, like the cutting or removing of corns, calluses and toenails. But Medicare may cover medically necessary podiatrist services for foot problems like hammertoes, bunion and heel spurs. Exams, treatments and therapeutic shoes or inserts may be covered if you have foot problems due to diabetes.
Overseas coverage: In most cases, health care outside of the United States is not covered by Medicare except for very limited circumstances – such as on a cruise ship within six hours of a U.S. port. Medigap supplemental plans D, G, M and N cover 80 percent of emergency care abroad. Some Medicare Advantage plans cover emergency care abroad.
The best way to find out what Medicare covers is to talk to your health care provider. Visit Medicare.gov/coverage and type in your test, item or service or download the Medicare “What’s covered” app on the Apple App Store or Google Play. To look for Medicare Advantage plans that offer additional benefits visit Medicare.gov/plan-compare.
Keep in mind that even if Medicare covers a service or item, it may not pay 100% of the cost. You will have to pay a monthly Part B premium (which is $144.60 for most beneficiaries in 2020) and unless you have supplemental insurance, you will have to pay your annual deductibles and copayments too. However, most preventive services are entirely covered by Medicare without copays or deductibles.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
Published February 28, 2020
