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8 Things Original Medicare Doesn't Cover

October 12, 2018

While original Medicare doesn’t cover the services outlined above, there are other options for coverage. For example, long-term care insurance can help pay for residential nursing home expenses, though these policies can be expensive and premiums rise quickly the older you get. And standalone vision, dental and hearing insurance is also available to help pay for routine exams, treatment, glasses and hearing aids.

Also, Part C Medicare Advantage plans often include regular vision and hearing exams, along with some dental services. Medicare Advantage plans are run by private insurance companies and take the place of Medicare Parts A and B, and most include Part D prescription drug coverage. Some of these plans cost no more than standard Medicare Part B, while others might be more expensive.

8 Things Original Medicare Doesn’t Cover

For people on Medicare coverage includes hospitalizations and many outpatient services, which can mean lower out of pocket medical costs. But it’s important to understand that Medicare doesn’t cover all medical expenses. Knowing what Medicare does — and doesn’t— cover can help you avoid unexpected medical bills.

Basic Medicare Benefits

Original Medicare includes two kinds of coverage: Part A and Part B. Medicare Part A is free to those who have paid into the program for at least 10 years through their payroll taxes. However, it does come with a $1,340 annual deductible. It covers:

  • Hospital stays
  • Skilled nursing
  • Hospice care
  • Some home health services

Medicare Part B comes with a $183 annual deductible and a monthly premium — $134 in 2018, if your annual income falls below $85,000. You’ll also pay a 20% copay after you’ve met the deductible. Medicare Part B covers:

  • Most doctor visits
  • A number of outpatient services
  • Medical equipment, including crutches and blood pressure monitors

Medicare beneficiaries also have the option of purchasing Part D prescription drug coverage, as a standalone plan or as part of a broader Part C Medicare Advantage plan.

You can find more information on Medicare benefits in this blog post.

What Original Medicare Doesn’t Cover

Medicare doesn’t cover a number of important health services. For the following eight services, you’ll be responsible for the full bill:

  1. Long-term nursing care. While Medicare does cover skilled nursing services in a rehab facility, it doesn’t cover costs for nursing homes or assisted living facilities.
  2. Personal care, including help with bathing, toileting and dressing, unless a patient is homebound and also receiving skilled nursing services.
  3. Adult day-care services in a facility that may offer social activities and/or health care assistance during the day.
  4. Routine dental care. Medicare doesn’t cover routine dental checkups, cleanings, fillings or dentures. Dental coverage for Medicare eligible may be available for some emergency situations or complicated procedures.
  5. Routine vision care. Regular eye examinations and glasses aren’t covered. However, Medicare does cover serious eye conditions, including glaucoma and cataract removal. Learn more about vision coverage options for Medicare eligbles.
  6. Routine hearing tests and hearing aids. Medicare doesn’t cover these services, although it does cover the cost of some hearing implants to treat severe hearing loss.
  7. Foot care. Medicare doesn’t pay for most routine foot services, such as corn and callous removal. And it doesn’t cover most orthopedic shoes and supports. However, Medicare will cover services related to foot injuries or diseases, including treatment of injuries and nerve damage related to diabetes.
  8. Alternative medicine. This includes acupuncture and most chiropractic services.
Options for Medicare Coverage

While original Medicare doesn’t cover the services outlined above, there are other options for coverage. For example, long-term care insurance can help pay for residential nursing home expenses, though these policies can be expensive and premiums rise quickly the older you get. And standalone vision, dental and hearing insurance is also available to help pay for routine exams, treatment, glasses and hearing aids.

Also, Part C Medicare Advantage plans often include regular vision and hearing exams, along with some dental services. Medicare Advantage plans are run by private insurance companies and take the place of Medicare Parts A and B, and most include Part D prescription drug coverage. Some of these plans cost no more than standard Medicare Part B, while others might be more expensive.