What Medicare Does Not Cover

Do you know what Medicare does not cover?  Americans usually become eligible for Medicare when they turn 65 years old.  You receive this benefit after paying social security taxes for many years.  Needless to say, it is a benefit that you work hard for and also deserve. After all, Medicare helps cover your medical expenses for the rest of your life.  However, there are many things that Medicare does not cover.

Ultimately, it is important to plan for these additional costs.  If you do not prepare, these expenses can cost you up to hundreds of thousands of dollars.  After reading this page, you will learn what medicare does not cover. This will help you plan ahead for what additional insurance coverage you may need.

You will pay deductibles, copays, coinsurances

Medicare Part A and Part B has deductibles, copays, and coinsurances.  

Part A (2022):  

• The Part A deductible for days 1-60 is $1,556.
• The copayment for days 61-90 is $389 per day.
• The copayment for days 91-150 is $778 per day.

Part B (2022):

• The annual deductible is $233.
• Once you meet the deductible, Medicare pays 80%.  Therefore you pay 20%.
• Providers that are not on medicare assignment can charge an excess charge of 15%.  To be clear, this is in addition to Medicare approved charges.

Original Medicare does not cover prescription drugs

Unfortunately, Original Medicare does not cover prescription drugs.  However, it may cover certain medications that doctors administer themselves.  To be sure, you should enroll in creditable prescription drug coverage.  It is important to do this as soon as you become eligible for Medicare. In fact, if you wait to enroll in a prescription drug plan later, you could face a late enrollment penalty.  Furthermore, this late enrollment penalty can follow you for as long as you have a prescription drug plan.

If you are lucky, then you may already have creditable prescription drug coverage through an employer, union, or other plan.  If you do not, then you may obtain coverage through a stand-alone Part D plan. As an alternative, you may choose a Medicare Advantage plan that includes drug coverage. For more information on Part D and when to enroll, read my post about prescription drug plans.

Medicare does not cover most dental services

Most dental services, unless medically necessary, are not covered by Medicare. For example, dentures, a common need for Seniors, are not covered.  Not to mention, dentures can cost up to several thousands of dollars.  On top of this, many dental insurance plans have a waiting period for dentures. Therefore it is important to be proactive in setting up your dental insurance plan.

Below are some examples of dental procedures that Medicare does not cover.

• Checkups
• Routine Cleanings
• Routine x-rays
• Extractions
• Fillings
• Crowns
• bridges
• Dentures
• Dental supplies
• Dental Plates

With all of this in mind, note that Medicare may cover some medically necessary dental procedures.  For example:

• Reconstructive surgery for a fractured jaw.
• Dental services for certain illnesses such as oral cancer.
• Necessary tooth extraction before a major surgery or procedure.
• Serious accident that affects your mouth.
• Certain dental services received in a hospital during an emergency.

Vision is usually not covered by Medicare

Most eye and vision care is not covered by Medicare. This may come as a shock if you are used to getting coverage through an employer plan.

Vision services that Medicare does not cover include:

• Routine vision exams
• Exams prescribing glasses or contacts
• The cost of glasses and contacts

Despite this, Medicare may cover medically necessary eye or vision care.  Examples of this include:

• Eye exams and tests for people with specific conditions. For example, glaucoma or diabetic retinopathy.
• Treatment for certain conditions like age-related macular degeneration.
• Initial Part B preventive care eye exam.
• Some cataract surgeries.
• Eyeglasses or contact lenses if after certain medically necessary procedures.

As a senior, the likelihood of needing eyeglasses is strong.  Fortunately, affordable vision insurance plans are available and can help cover these additional costs.  Like dental and hearing plans, vision plans often have a waiting period for glasses and contacts.  Therefore it is important to plan ahead.

Original Medicare does not cover hearing aids

Unfortunately, hearing loss is a very common condition in seniors.  As a matter of fact, it affects one out of every three seniors between the ages of 65-74, according to an article from NIH.

Medicare usually does not cover hearing aids.  In addition, it does not cover hearing aid exams, and hearing aid fittings.  However, there are some exceptions.  For example:

• Medically necessary hearing and balance exams.
• Surgically implanted devices like cochlear implants.

Surprisingly, hearing aids can cost over one thousand dollars.  Similar to the wait time for dentures with dental plans, many hearing insurance plans also have a wait time for hearing aid coverage.  Therefore it is equally important to plan ahead.

Medicare does not cover alternative medicine

Medicare does not cover alternative medicine.  Examples of this include:

• Acupuncture
• Massage
• Medical marijuana
• Chiropractic services
• Experimental treatments

Like other categories, there may be some exceptions for chiropractic treatments that are medically necessary.  However the doctor must provide evidence.

International care is usually not covered by Medicare

Original medicare does not cover health care outside of the United States.  This is with the exception of some emergency services or other rare circumstances.

Because of this, you may want to look at plans that cover medical costs overseas.  Especially if you travel outside of the United States often.  Some examples include:

• Medicare supplement plans that cover up to 80% of emergency medical claims internationally.
• Medicare Advantage plans that include coverage for overseas emergency services.
• Travel-medical policies.

Non-medical services

Non-medical services are also not covered by Original Medicare.   Therefore, you may have unexpected expenses if you stay in a hospital.

Examples of non-medical services include:

• Private room
• Hospital TV
• Hospital Phone
• Copies of X-rays
• Non-emergency transportation

Long-term care coverage

Unfortunately, long-term care is also not covered by Medicare.  It is important to note that this may be one of the largest costs for many seniors.  For example, the cost to reside in a nursing home or assisted living facility is more than the average American’s yearly salary.

Some examples of long-term care include:

• Skilled Nursing Facility
• Assisted Living Facility
• Independent Living Facility
• Enriched Housing
• Family Type Home
• Adult Home
• Life Care Community
• Home Health Care
• Memory (Alzheimer’s)  Care
• Adult Day Care

Medicare Part A pays for some skilled nursing facility costs for stays under 120 days. You will pay:

• $0 for days 1-20
• $194.50 per day for days 21-100 in 2022
• All costs for stays over 100 days

If you stay in a hospital for at least 3 days, Part A will help cover skilled nursing treatment you may need after your stay.  If your hospital stay is not “admitted”, then Part A will not cover it.

Examples of costs include:

• Skilled nursing
• Meals
• Room (usually semi private)
• Rehabilitation
• Injections
• Help with bathing and eating

Fortunately, long-term care insurance options are available and can help cover these costs.  It is important to plan ahead.  Indeed, the earlier in life you enroll in a plan, the lower the premium will usually be.

Personal and custodial care

Medicare doesn’t cover personal care or custodial care. These are services that you may take for granted before your senior years.  However, you will likely need these services when facing an illness.  This is especially true if you are living alone.  But it is also true if you are living with someone unable to provide help to you.

Examples of personal care:

• Bathing
• Dressing
• Getting in and out of bed
• Eating
• Toileting
• Grooming

Examples of custodial care:

• Housekeeping
• Shopping
• Meal delivery and preparation

Medicare does not cover many equipment & supplies

Although you may not realize it, you may need certain pieces of equipment as a senior.  The right equipment not only keeps your living area safe, but also adds to your comfort.  Unfortunately, Medicare does not cover many of these items.  For example:

• grab bars for your bathroom or bed
• stair lifts or elevators
• bathtub lifts or seats
• medical emergency alert systems
• Rubber mats
• Adjustable beds
• Hand rails

On the positive side, some safety items may be covered. However, your doctor must provide proof that it is medically necessary.  For example, a wheelchair ramp that you need for medical reasons may qualify as necessary.

Fitness programs

Fitness programs are not covered by Original Medicare.  Even so, they can be important for your overall health as a senior.  Furthermore, participation in a fitness program is a preventative measure.  As a result, it can help keep medical costs down.  Not only this, but it will also help you to feel your best.

Fortunately, some Medicare Advantage plans may include fitness programs.  They may offer discounts for gym or health club memberships.  Alternatively, many fitness facilities also offer discount membership rates for seniors.

routine foot care

Unfortunately, Medicare does not cover routine foot care. However, some podiatrist services that are deemed medically necessary are exceptions.  Of course, your provider will need to provide evidence.

Examples of routine foot care not covered include:

• toenail clipping
• corn removal
• callus removal
• nail maintenance
• foot cleaning

Examples of foot care that may be covered include:

• Services for foot injuries (hammer toes, bunions, heel spurs)
• Foot exams for specific conditions like:  diabetes, cancer, kidney disease, multiple sclerosis
• Orthopedic shoes
• Custom-molded shoes and inserts for diabetics

Cosmetic surgery

It almost goes without saying that Medicare does not cover cosmetic surgery.  However,  there are some exceptions.  For instance, some procedures that can help an injury or deformity.  Nonetheless, you should never assume that Medicare covers your cosmetic surgery.  It should be noted that Medicare covers cosmetic procedures only in rare circumstances.

For example:

• Artificial limbs
• Artificial eyes
• Breast reconstruction due to breast cancer
• Excess skin removal if the skin causes infections or rashes
• Rhinoplasty that improves bodily function

What if I can’t afford these costs that Medicare does not cover?

Understandably, all of these potential expenses may overwhelm seniors.  Luckily, insurance plans are available to help cover many of these extra costs.

However, if you cannot afford additional insurance plans, you may qualify for government programs.  More specifically, programs like Medicaid or Extra help may help pay some of these costs.  If you think you may qualify for these programs, contact social security at 1-800-772-1213.

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