Original Medicare covers many things, but not everything. These are the services that Medicare usually doesn’t offer coverage for.
Knowing what’s covered by Medicare and what isn’t can save you money and stress.
One of the things that makes Medicare such a useful health care solution for seniors and eligible citizens is the comprehensive coverage that it offers. While this is an obvious plus, there are some things that Medicare doesn’t usually cover. There are also some things that it only partially covers. We talk a lot about what Medicare covers on Medicareful Living, but discussing what generally isn’t covered is equally important, if not more important.
For this article, we’ll be focusing in on Original Medicare. Since Medicare Advantage (Part C) plans can have differing coverage from plan to plan, they may cover some of these entries in some way. If that’s the case, we’ll make a note that it may be an option for you. Otherwise, if you think you’ll need one of these services, you’ll want to look at the specifics of a certain plan to make sure it’s the right one for you. If you have particular health care needs that relate to the items we’ll discuss below, it may also be worth working with a licensed Medicare sales agent to find the plan for you or checking out the Medicareful Plan Finder.
Hearing Aids
Hearing loss is a condition about one in three seniors ages 65 to 74 around the country face. In fact, by the time they’re 75, nearly half of all seniors experience some form of hearing loss. This can make being able to get a hearing aid vital to maintaining a good quality of life. Unfortunately, Medicare rarely covers hearing aids, hearing exams, and hearing aid fittings. Specifically, Original Medicare only covers hearing aids if they’re bone-anchored hearing aids (BAHA), since those types of hearing aids are now considered prosthetics also rarely, if ever, cover hearing aids.
Can I Get It Covered?
If you find yourself needing hearing aids, there are a few places you can turn. First, you can try a Medicare Advantage plan. Many offer some form of hearing coverage, though you may still have some out-of-pocket costs with a purchase. Medicaid may also offer hearing aid coverage, depending on the state and if you qualify for coverage. Some private charities and associations, like the Starkey Group, can offer financial aid. The Hearing Loss Association of America also offers information about how to get financial aid for those in need. Finally, you can find a standalone dental, vision, and hearing insurance plan to cover all three needs and supplement your Medicare coverage.
Routine Dental Work and Dentures
Speaking of dental coverage, routine dental work is not covered by Original Medicare. This means you’ll likely be paying out of pocket for dentist visits, cleanings, and even dentures if you have Medicare. The only way that Original Medicare may cover dental work is if it’s part of something that Original Medicare normally covers, like surgery as part of inpatient care. In a circumstance where there is some coverage of dental care, a Medicare Supplement may help by possibly covering deductibles and coinsurances.
Can I Get It Covered?
Many Medicare Advantage (Part C) plans offer some form of dental coverage, though this differs from plan to plan and is limited to certain services. Part C plans often will cover routine coverage like checkups, preventative cleanings, and oral exams, to name only a few. However, this coverage typically doesn’t extend, or fully extend, to some major dental procedures like crowns or dental items like dentures. This can make reading the fine print of your Medicare Advantage plan very important. If you want coverage for dentures or routine dental procedures, it may also be worth finding a stand-alone dental plan or a combination dental, vision, hearing plan.
Routine Vision Care
So, we’ve discussed dental and hearing, and how they’re generally not covered by Medicare. But, is eye care covered? Unfortunately, that’s also a no, if you’re referring to routine care. Luckily, Original Medicare does cover certain preventative and diagnostic exams for conditions like glaucoma, diabetes, and macular degeneration. It can also cover things like medically-necessary cataract surgery. However, services and checkups, like regular eye exams or glasses or contact lens fittings, generally aren’t covered by Original Medicare. The same goes for Medigap plans, which do not cover routine vision services. This means that 100 percent of the costs of these regular checkups and fittings will be out-of-pocket expenses for you.
Can I Get It Covered?
Similar to with dental and hearing, you can get many of your vision coverage needs in the right Medicare Advantage plan. A large number of Part C plans cover vision benefits in some way, though the amount covered and the costs associated with this coverage varies between plans. While it doesn’t cover the checkups, you can also get some vision coverage through Medicare Part D. This coverage is largely related to vision medications and prescription eye drops and differs depending on the plan you have. You can also get a stand-alone vision insurance plan or a combined dental, vision, and hearing plan to help cover your vision needs.
Custodial Long-Term Care Services
There may come a point in your life when you require help with daily tasks beyond what your family and friends can provide. You may eventually need long-term care services. If you need help with everyday tasks like eating, washing, and dressing, this would be considered custodial long-term care. Since this type of help is not considered medically necessary, Original Medicare won’t assist with paying for this type of long-term care. It may assist with the costs of a skilled nursing facility services, like a semi-private room or prescription drugs, if they become medically-necessary but the custodial care is still your responsibility.
Can I Get It Covered?
Luckily, unlike other options in this article, there are ways to get help from Original Medicare for long-term care. If you qualify for PACE or hospice care, certain long-term care needs may be covered. Original Medicare may also assist with long-term care hospitals or some home health services. Medicaid can help cover some costs of long-term care as well. Alternatively, you can enroll in a long-term care insurance plan to have all your bases covered.
Cosmetic Surgery
Cosmetic surgery usually isn’t covered by Original Medicare. In fact, there are very few circumstances where cosmetic surgery is covered. Most cosmetic surgery is considered to be elective or non-essential surgery since it’s not medically-necessary and often done to fix a certain perceived physical imperfection. This differs from plastic surgery, which is often focused on reconstruction or defects due to birth disorders, trauma, or disease.
Can I Get It Covered?
The difference between cosmetic surgery and plastic surgery can make a large difference in your coverage. Original Medicare will cover cosmetic or plastic surgery if it’s caused by an accidental injury or to improve function of a malformed body part. It may also cover breast prostheses if you’ve had a mastectomy due to breast cancer. Some companies also offer cosmetic surgery insurance, though this is rare and should be thoroughly researched before purchasing. The non-essential nature of most cosmetic surgery procedures makes coverage for it rare, meaning you’ll likely be footing the entire bill.
Care Outside of the U.S.
Let’s say you’re on vacation and you get sick. You need health care. Does Medicare cover you? If you happen to be inside the United States, generally speaking, you should be able to get coverage, depending on the service. Original Medicare is accepted throughout the country. With Medicare Advantage, the answer is a little murkier since they have plan networks. If you’re venturing outside of the country, though, you won’t likely receive the same Medicare coverage you’re used to, if any.
Can I Get It Covered?
There are a few instances where Medicare can cover some of your expenses outside of the United States, though they are very specific. These are:
If you have a health emergency in the U.S., but the nearest hospital that can assist you is in another country.
If you’re in Canada while traveling the most direct route between Alaska and the continental U.S. when the emergency occurs. In this case, a Canadian hospital must be the closest hospital and your trip must not be taking any “unreasonable delay[s].”
If you live in the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition. In this instance, a medical emergency is not required for coverage.
Otherwise, you’ll likely be covering your own bills. You may be able to get a travel insurance plan, though not all of them cover health care, so read the coverage closely before enrolling in a plan. Finally, some Medicare Supplements and Medicare Advantage plans offer coverage for foreign travel, which can be wise if you’re planning on traveling abroad.
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Medicare, and specifically Original Medicare, covers many of the crucial health care needs of seniors and eligible Americans around the country. But, it can’t cover everything. Luckily, if you do need one of the health care services or items that aren’t traditionally covered by Original Medicare, there’s often a way to get some financial assistance. This way, you can afford the care you need without your quality of life being impacted. While this could mean that Medicare isn’t the only insurance you may need depending on your circumstances, it’s good to know that there are options out there.
