In this article
- 1 What Medicare doesn't cover
- 2 1) Dental Work
- 3 2) Opticians & eye exams
- 4 3) Hearing Aids
- 5 4) Custodial Care
- 6 5) Overseas Care
- 7 6) Most Prescription Drugs
- 8 7) Cosmetic Surgery
- 9 8) Chiropractic Care
- 10 9) Massage Therapy
- 11 10) Podiatry
- 12 11) Concierge Care
- 13 12) Weight Loss Medication
- 14 13) Adult Diapers
- 15 Where can I find out if a test, medical item, or service is covered by Medicare?
- 16 Takeaways
What Medicare doesn't cover
Most older Americans have their healthcare needs covered by Medicare, from doctor visits and prescriptions to lab test and hospitalization. But there are some things that Original Medicare is not designed to cover.
Here’s a list of 13 things that are not part of Original Medicare- and how you might go about covering them.
Note– VA health benefits include a lot of services not typically covered by Original Medicare. Depending on your level of disability, you may qualify for certain covered services. You can check your eligibility and apply for benefits here.
1) Dental Work
Original Medicare and Medigap plans do not cover dental work such as routine exams, dentures, or root canals.
How to cover:
Some Medicare Advantage plans offer dental coverage. Otherwise, consider an individual dental policy or a dental discount plan.
2) Opticians & eye exams
Original Medicare covers expenses such as cataract surgery, but routine eye exams, glasses, and contact lenses are not covered. And while Medigap plans also do not cover this service, some Medicare Advantage plans do offer routine vision care.
How to cover:
For people that need it, purchasing a standalone vision plan makes a lot of sense to help with the cost of prescription glasses or contact lenses.
3) Hearing Aids
Medicare will cover hearing aids only for ear-related medical conditions. For all other needs, Original Medicare and Medigap plans will not pay for routine test or hearing aids.
How to cover:
If you are on a Medicare Advantage plan, check to see if this is covered. If you lack this coverage, consider a standalone policy.
As of 2017, Medicare beneficiaries with mild to moderate hearing loss could purchase hearing aids over the counter at drug stores and other retail outlets.
4) Custodial Care
While Medicare will pay for limited stays in a skilled nursing facility (rehab), if you become so frail or sick that you need to move into an assisted living facility or nursing home, Medicare will not cover your custodial cost. Seven out of ten Americans will need this type of care at some point in the lives.
How to cover:
Long-term care can exceed $100,000 per year for a private room depending on where you live. Long-Term Care insurance and Short-Term Care insurance both help to cover these cost, as can certain riders on life insurance policies and some annuities.
For this with limited income and savings, Medicaid can help fill the gaps.
5) Overseas Care
Original Medicare and Medicare Advantage plans offer almost zero coverage for cost incurred outside the US.
How to cover:
Some Medigap plans cover this in limited amounts. If you travel frequently, consider travel insurance; it is pennies on the dollar and can save quite a lot when needed.
6) Most Prescription Drugs
Depending on where you receive medications, your Medicare Part A or Part B may cover the cost. But for most of the prescription drugs many Americans take each day, Original Medicare will not cover the bill.
How to cover:
Either a standalone Part D Prescription Drug plan or an MAPD are the most common ways to cover this. Those with certain military benefits can use the VA instead.
7) Cosmetic Surgery
For the most part, cosmetic surgery is considered an elective and is not covered. There are exceptions, such as plastic surgery following a mastectomy or accidental injury, but face-lifts and tummy tucks are out of the question.
How to cover:
If this is something that you know you will need to cover, consider a separate savings account for this cost.
8) Chiropractic Care
With the exception of a single specific service and the occasional pain relief, Original Medicare does not cover most chiropractic services or test.
How to cover:
Some Medicare Advantage plans will cover these services and sometimes the chiropractors themselves offer payment plans to help you pay for the services.
9) Massage Therapy
This is not covered normally.
How to cover:
Talk to your healthcare provider and ask if they can recommend massage therapy as a way for pain management, which Medicare will cover. Some Medicare Advantage plans also cover this service, but make sure to check with your plan first.
10) Podiatry
Medicare Part B will cover some exams or treatments due to nerve damage from diabetes or bone spurs, but routine medical care for feet is not covered.
How to cover:
If this is something that you know you will need to cover, consider a separate savings account for this cost.
11) Concierge Care
Some providers require that members pay a fee to use their services. While Medicare will not pay this fee, if the providers accept Medicare, you will be able to use them as you would any other provider.
How to cover:
If you are dead set on using a concierge doctor, you’ll need to pay the fee.
12) Weight Loss Medication
Ozempic, Wegovy, and Mounjaro are some of the more popular medications taken for weight loss. Many health insurance plans, including Medicare, will not cover these medications for that purpose.
The exception to this is if you take these medications to treat diabetes, Medicare may cover them under your Part D medications.
How to cover:
You can ask your provider for free samples of try and find them through GoodRx which often has coupons. You may be able to use your FSA or HSA for these.
13) Adult Diapers
As our bodies age, controlling our bladders becomes a problem, and many people benefit from adult diapers. Medicare, however, considers these to be for personal hygiene and not for medical treatment and will not cover the cost.
How to cover:
Some Medicaid programs and certain Medicare Advantage plans cover some of the cost for these.
Where can I find out if a test, medical item, or service is covered by Medicare?
The easier way is to visit the Medicare website here or to call 1-800-Medicare (1-800-633-4227) and speak with a representative.
Takeaways
Medicare provides essential health coverage for millions of adults and certain younger individuals with disabilities and specific medical conditions, but it does have its limits.
It is important to plan and have a realistic conversation about things that may financially affect you down the road. If you’re ready to have that conversation or want to talk about anything else, feel free to give us a call and we can chat.
- The Living Benefits of Life Insurance - December 29, 2024
- The (dis)advantage to Medicare Advantage plans - December 18, 2024
- Options when full health insurance isn’t feasible - December 2, 2024
