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Medicare: What’s Not Covered

| October 25, 2023

       I've explained in prior writings that Original Medicare Part A and Part B provide vital healthcare coverage to millions of individuals across the United States. Part A covers hospital and inpatient care, while Part B focuses on medical services and outpatient care.

       However, it is crucial to understand that Medicare does not cover all healthcare expenses. Because, there are several gaps in coverage that beneficiaries need to be aware of, which can lead to out-of-pocket expenses. Here we will explore the top 9 services that are not covered by Original Medicare.

1. Long-Term Care

Medicare does not cover long-term care, such as nursing home care or assisted living facilities, except in limited circumstances following a hospital stay. If you require extended care due to chronic illness or disability, you will need to explore other options like Medicaid, long-term care insurance, or personal savings.

2. Prescription Drugs

Medicare Part A and Part B do not provide coverage for most prescription drugs. To obtain prescription drug coverage, beneficiaries must enroll in a standalone Part D plan or choose a Medicare Advantage plan that includes drug coverage. These plans may come with premiums, deductibles, and copayments.

3. Dental Care

Routine dental services, including check-ups, cleanings, fillings, and dentures, are not covered by Medicare. While some dental services may be covered if deemed medically necessary, cosmetic dental procedures like teeth whitening and veneers are not covered by Medicare. Some Medicare Advantage plans offer limited dental coverage, but it is essential to understand the terms and limitations of these benefits. Consider purchasing a separate dental insurance plan for comprehensive coverage.

4. Vision Care

Medicare typically does not cover routine eye exams, eyeglasses, or contact lenses. It does cover eye exams for beneficiaries with diabetes or those at high risk for glaucoma. To cover vision-related costs, consider standalone vision insurance or a Medicare Advantage plan that includes vision benefits.

5. Hearing Aids

Original Medicare does not cover the cost of hearing aids or routine hearing exams. However, some Medicare Advantage plans may provide limited hearing aid coverage. To address hearing-related expenses, explore options such as hearing aid insurance or private hearing aid coverage.

6. Cosmetic Surgery

Medicare does not cover elective cosmetic surgery unless it is deemed medically necessary. Procedures done solely for aesthetic reasons, such as facelifts, breast augmentation, or liposuction, are typically not covered.

7. Acupuncture and Alternative Therapies

Alternative therapies like acupuncture and chiropractic services are generally not covered by Medicare. Some specific Medicare Advantage plans may offer limited coverage for alternative therapies, so check the plan details if you are interested in these services.

8. International Travel Emergency

Medicare Part A and Part B do not cover healthcare services received outside the United States except in specific emergencies. Travelers should consider purchasing additional travel health insurance or a Medigap plan with international coverage for peace of mind when traveling abroad.

9. Routine Foot Care

Medicare typically does not cover routine foot care, such as nail trimming, callus removal, or bunion treatment, unless related to a medical condition like diabetes. Beneficiaries with specific foot issues may need to seek additional coverage through a Medicare Advantage plan or supplemental insurance.

       Original Medicare offers vital healthcare coverage, but there are significant gaps in what they do not cover. To address these limitations, beneficiaries have several options, but they all begin with attaining some sort of secondary insurance. It is essential to review your healthcare needs and research available plans to ensure you have comprehensive coverage that aligns with your health and financial goals. Understanding what Medicare does not cover is the first step toward making informed decisions about your healthcare coverage. Give us a call and see how one of our agents can help.