What Services Does Medicare Not Cover?

Vincent Thrasher

Founder at - over65 insurance options

Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior...Read more

Medicare is a health insurance program that provides coverage for millions of Americans aged 65 and over. However, not all healthcare services are covered under Medicare, which can be a surprise to many new beneficiaries. It’s important to understand what Medicare does not cover to avoid any unexpected healthcare costs down the road.

While Medicare covers a wide range of healthcare services, there are some gaps in coverage. For example, Medicare does not cover dental, vision, or hearing care, which can be essential for maintaining overall health and wellbeing. In this article, we’ll explore what services Medicare does not cover and what options you have for filling in those gaps.

What Services Does Medicare Not Cover?

Medicare is a federal health insurance program that provides coverage for people who are 65 years or older, as well as those under the age of 65 with certain disabilities or chronic conditions. While Medicare covers a wide range of medical services, there are certain treatments and procedures that are not covered by the program. Here are the services that Medicare does not cover:

1. Long-term care

Medicare does not cover long-term care, which refers to the range of services that support people who are unable to care for themselves due to chronic illness or disability. This can include assistance with activities of daily living, such as bathing, dressing, and eating, as well as help with managing medication and other medical needs.

While Medicare does not cover long-term care, there are other programs that can help with these costs, such as Medicaid and long-term care insurance.

2. Dental care

Medicare does not cover routine dental care, such as check-ups, cleanings, and fillings. However, there are some exceptions to this rule. For example, Medicare may cover dental services that are necessary for medical reasons, such as oral surgery related to a medical condition.

If you need dental care that is not covered by Medicare, you may want to consider purchasing a separate dental insurance policy or paying for the services out of pocket.

3. Eye exams and glasses

Medicare does not cover routine eye exams or eyeglasses, except in certain situations. For example, Medicare may cover an eye exam if you have diabetes or are at high risk for glaucoma.

If you need vision care that is not covered by Medicare, you may want to consider purchasing a separate vision insurance policy or paying for the services out of pocket.

4. Hearing aids

Medicare does not cover hearing aids or exams for fitting hearing aids. However, there are some Medicare Advantage plans that may provide coverage for these services.

If you need a hearing aid that is not covered by Medicare, you may want to consider purchasing a separate hearing insurance policy or paying for the services out of pocket.

5. Cosmetic surgery

Medicare does not cover cosmetic surgery, which refers to procedures that are performed for aesthetic reasons rather than medical necessity. This can include procedures such as breast augmentation, facelifts, and tummy tucks.

If you are considering cosmetic surgery, you will need to pay for the procedure out of pocket or through a separate insurance policy.

6. Acupuncture

Medicare does not cover acupuncture, which is a form of alternative medicine that involves inserting thin needles into the skin at specific points on the body. However, some Medicare Advantage plans may provide coverage for acupuncture.

If you are interested in acupuncture, you may want to check with your Medicare Advantage plan to see if this service is covered.

7. Prescription drugs

While Medicare does cover some prescription drugs, there are certain medications that are not covered by the program. This can include drugs that are not approved by the FDA, as well as drugs that are used for cosmetic purposes.

If you need a prescription drug that is not covered by Medicare, you may want to consider purchasing a separate prescription drug insurance policy or paying for the medication out of pocket.

8. Experimental treatments

Medicare does not cover experimental treatments, which are medical procedures or drugs that are still in the testing phase and have not yet been approved by the FDA.

If you are interested in participating in an experimental treatment, you will need to pay for the procedure out of pocket or through a separate insurance policy.

9. Travel outside the US

Medicare does not cover medical care that is received outside of the United States, except in certain situations. For example, Medicare may cover emergency care that is needed while you are traveling outside of the US.

If you are planning to travel outside of the US, you may want to consider purchasing a separate travel insurance policy that provides coverage for medical care.

10. Private duty nursing

Medicare does not cover private duty nursing, which refers to care that is provided by a registered nurse or licensed practical nurse in the home. However, there are other programs that can help with these costs, such as Medicaid and long-term care insurance.

If you need private duty nursing that is not covered by Medicare, you may want to consider purchasing a separate nursing insurance policy or paying for the services out of pocket.

In conclusion, Medicare covers a wide range of medical services, but there are certain treatments and procedures that are not covered by the program. If you need any of these services, you will need to pay for them out of pocket or through a separate insurance policy. It is important to understand what is and is not covered by Medicare so that you can plan accordingly and make informed decisions about your healthcare.

Frequently Asked Questions

What services does Medicare not cover?

Medicare does not cover certain services that are considered medically unnecessary or cosmetic. Some of the services that Medicare does not cover include:

Firstly, long-term care services such as custodial care, which involves assistance with daily living activities such as bathing, dressing, and eating. Medicare only covers short-term skilled nursing care for medically necessary reasons.

Secondly, dental care, including routine check-ups, cleanings, fillings, and dentures. Medicare only covers dental services that are medically necessary for the treatment of a medical condition.

Does Medicare cover vision and hearing care?

Medicare does not cover routine vision and hearing care such as eye exams, eyeglasses, or hearing aids. However, Medicare does cover certain vision and hearing services that are medically necessary such as cataract surgery or hearing tests ordered by a doctor.

If you need routine vision or hearing care, you may want to consider enrolling in a Medicare Advantage plan or purchasing a separate vision or hearing insurance policy.

Does Medicare cover prescription drugs?

Medicare does cover prescription drugs, but only if you are enrolled in a Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage. These plans are offered by private insurance companies and require you to pay a monthly premium.

It’s important to review your Medicare plan each year during the open enrollment period to ensure that your prescription drug needs are covered and that you are getting the best value for your money.

Does Medicare cover medical care when traveling outside of the United States?

Medicare does not typically cover medical care that you receive while traveling outside of the United States. However, there are some exceptions such as:

Firstly, if you are on a cruise ship within 6 hours of a United States port.

Secondly, if you are traveling through Canada on the most direct route between Alaska and another U.S. state.

You may want to consider purchasing a separate travel insurance policy that includes medical coverage if you plan to travel outside of the United States.

Does Medicare cover alternative or complementary therapies?

Medicare does not cover alternative or complementary therapies such as acupuncture, chiropractic care, or massage therapy. However, some Medicare Advantage plans may offer coverage for these services.

If you are interested in alternative or complementary therapies, you may want to consider enrolling in a Medicare Advantage plan that offers coverage for these services or purchasing a separate insurance policy that covers them. It’s important to review your options and costs carefully before making a decision.

5 Things Medicare Doesn’t Cover (and how to get them covered)

In conclusion, understanding what Medicare doesn’t cover is just as important as knowing what it does cover. While Medicare provides coverage for many medical services, it doesn’t cover everything. It’s essential to be aware of the services that are not covered so that you can plan accordingly and avoid unexpected costs.

Some of the most common services that Medicare doesn’t cover include dental care, eye exams for glasses, hearing aids, and long-term care. However, there are other services that are not covered by Medicare, so it’s crucial to read the fine print and understand what your plan covers.

To ensure that you have the best coverage possible, it’s essential to do your research and consider supplemental insurance options. By doing so, you can avoid costly surprises and make sure that you have access to the medical care you need.

In summary, Medicare is an essential program that provides coverage for many medical services. However, it’s important to understand what is not covered so that you can plan accordingly and avoid unexpected costs. By doing your research and considering supplemental insurance options, you can ensure that you have the best coverage possible.

Vincent ThrasherFounder at - over65 insurance options

Vincent Thrasher, the pioneering founder of Over65InsuranceOptions, has an impressive 20-year tenure in the insurance industry. His in-depth expertise spans the entire spectrum of senior insurance, encompassing Medicare, Medigap, long-term care insurance, life insurance, and dental, vision, and hearing insurance. Vincent's unwavering passion for guiding seniors through the intricate insurance landscape and crafting customized solutions to address their individual needs has earned Over65InsuranceOptions an esteemed reputation as a dependable ally for seniors nationwide.

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