As we age most of us need eye care, dental work, foot care, hearing aids, and additional medical care, but Medicare generally won’t pay for any of these health services. And if you need extensive long-term carea variety of services that help people with their medical and non-medical needs over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including..., Medicare only covers you for a limited time and under particular circumstances.
Here’s a look at some of the most common medical services Medicare doesn’t cover that MedicareWire thinks you should know about.
Key Takeaways
- Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. (Part A and Part B) covers about 80% of most major medical costs.
- Original Medicare does not cover minor medical costs, including most dental, vision, and hearing services.
- Prescriptions are not covered by Original Medicare, but most drugs that are administered if you are an inpatient, and many preventive care vaccines are covered.
- Many Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). cover prescription, vision, dental, hearing, and other services, such as healthcare transportation.
- Although most Medicare Advantage plans offer more coverage options than Original Medicare, cosmetic surgery is not covered. The same is true when it comes to long-term care.
- Neither Original Medicare nor Medicare Advantage plans cover foreign travel emergencies. However, some Medicare SupplementsMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. offer this coverage.
1. Dental Care
Medicare doesn’t pay for routine dental care, including cleanings and fillings. Dentures, implants, and other types of dental devices aren’t covered either. Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. does pay for certain dental services received if you are hospitalized, but only if the services are medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.. For your routine dental care needs, you’ll need to buy a dental plan or enroll in a Medicare Advantage plan with dental coverage. You can find and compare dental plans for seniors here.
2. Hearing Aids
Most people find it challenging to hear clearly as they age, especially in a noisy environment. Medicare doesn’t cover hearing aids or the exam required to select and fit an appropriate hearing device. However, Medicare might cover an exam if your doctor determines it’s medically necessary (e.g., balance-related). And Medicare covers surgically implanted devices, such as cochlear implants that offer a sense of sound.
3. Routine Eye Exams
Medicare covers eye exams and tests for people with specific conditions, such as an annual glaucoma test for high-risk retirees, a yearly eye exam for diabetic retinopathy, and tests and treatments for age-related macular degeneration. However, vision checks for the purpose of prescribing glasses and contact lenses are not covered. The single exceptionIn a Medicare Part D plan, an exception is a type of prescription drug coverage determination. You must request an exception, and your doctor must send a supporting statement explaining the medical reason for the... to this rule is your “Welcome to Medicare” preventive care visit that you get during the first 12 months you have Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services..
4. Glasses and Contact Lenses
Most of us need corrective lenses to see clearly as we age, but Medicare doesn’t cover the cost of glasses or contact lenses for most people. But, if you need cataract surgery and your doctor implants an intraocular lens, Medicare will cover one pair of eyeglasses or one set of contact lenses from a Medicare-approved supplier.
5. Routine Foot Care
Medicare covers podiatry services for injuries to the foot, including hammer toes, bunions, and heel spurs. However, Medicare doesn’t cover foot care such as the removal of calluses and corns, nail maintenance, or foot cleaning. Exams and treatment are covered if needed in the treatment of a chronic condition, such as diabetes. This includes custom-molded shoes and inserts for those with severe diabetic foot disease and orthopedic shoes if you have a leg brace.
6. Acupuncture
Many people swear by acupuncture to relieve various ailments, but it’s not covered by Medicare. You can get your chiropractor visits for medically necessary manipulation of the spine covered, but Medicare may not cover other chiropractic services, such as X-rays and massage therapy.
7. Cosmetic Surgery
Medicare doesn’t cover cosmetic surgery unless it’s medically necessary. For example, Medicare will typically pay for the surgery if it is required because of an injury or deformity. Common instances include artificial limbs and their replacement parts, artificial eyes, and breast prosthesis after a mastectomy.
8. Medical Care Received Outside the U.S. and its Territories
Medicare does not cover health services received in another country. However, there are circumstances when Medicare will pay, such as if a foreign hospital is closer than the nearest U.S. hospital for a beneficiaryA person who has health care insurance through the Medicare or Medicaid programs. injured in the U.S. The most common example is receiving emergency medical services in Canada while traveling between the continental U.S. and Alaska. If you plan to travel abroad, buy a Medicare supplement plan or travel insurance.
9. Personal Care & Long-Term Care
Medicare typically won’t cover the cost of personal care services, including help for bathing, dressing, getting out of bed, shopping, housekeeping, meals delivered to your home, or 24-hour assistance at home. If you’re poor you might qualify for custodial careNon-skilled personal care, such as help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. costs through MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..
Medicare does cover short-term care in a skilled nursing facility if it follows a hospital stay of three or more days. Although you don’t have any cost-sharing during the first 20 days of care, you’ll pay $204 per day for days 21 through 100. Medicare does not cover nursing home stays that exceed 100 days. For this, you’ll need long-term care insurance. For information about LTC coverage, you can read the MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. Long-Term Care insurance guide here.
Summary
Although Medicare covers most of your major medical costs, it doesn’t cover everything. To make sure you have coverage for your dental, vision, hearing, long-term care, and other healthcare needs as you age into retirement, you’ll need to plan ahead and buy additional coverage.