What Is Not Covered by Medicare Part A and Part B?

Medicare provides coverage for a wide range of services and products, but it doesn’t cover everything. In this guide, we take a look at what is not covered by Original Medicare (Medicare Part A hospital insurance and Part B medical insurance).

We also detail some of the options you may have for coverage that Original Medicare doesn’t offer, such as Medicare Part D prescription drug coverage and Medicare Advantage (Medicare Part C) plans.

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Prescription drugs

Original Medicare does not cover most prescription drugs. Only a select few prescription drugs are covered by Original Medicare, and only under limited conditions.

Some of the drugs Medicare Part B does cover can include:

  • Drugs used with an item of durable medical equipment such as a nebulizer
  • Certain antigens
  • Injectable osteoporosis drugs
  • Erythropoietin by injection
  • Blood clotting factors
  • Oral drugs given for End-Stage Renal Disease
  • Enteral nutrition, such as intravenous and tube feeding
  • Intravenous Immune Globulin (IVIG) that is provided at home
  • Transplant and immunosuppressive drugs

Medicare Part B also covers vaccinations and flu shots.

For prescription drug coverage, Medicare beneficiaries can consider enrolling in a Medicare Advantage plan that covers prescription drugs or a standalone Medicare Part D drug plan.

Routine dental care or dentures

Original Medicare may pay for certain dental services that you receive as a hospital inpatient, such as emergency facial and oral care or complicated oral surgery that is medically necessary to your overall health.

Medicare Part A and Part B do not cover routine dental care such as dental exams, cleanings, fillings, tooth extractions or dentures.

Medicare beneficiaries who want dental coverage may consider enrolling in a Medicare Advantage plan that covers dental care.

Vision care and eyeglasses

Original Medicare does not cover eye exams, eyeglasses or contact lenses unless you have cataract surgery to implant an intraocular lens.

An annual glaucoma test can be covered by Medicare Part B, but only for those who are considered to be at a high-risk for the disease. Eye exams for diabetic retinopathy can be covered once a year, but only if you have diabetes.

Medicare beneficiaries who want coverage for routine vision care, glasses and contact lenses may consider a Medicare Advantage plan that offers vision benefits.

Routine hearing care and hearing aids

A diagnostic hearing exam may be covered by Medicare Part B, if it’s ordered by a doctor or other health care provider to see if you need medical treatment. Routine hearing checks are not covered, however, nor is the cost of hearing aids.

If you are a Medicare beneficiary who wants coverage for your hearing care and hearing aids, you may be able to find the benefits you need by joining a Medicare Advantage plan with hearing coverage.

Most health care received outside of the U.S.

Medicare does not typically cover most health care received outside the United States, Puerto Rico, the Northern Mariana Islands, Guam, American Samoa and the U.S. Virgin Islands. The only exceptions involve emergency care under certain circumstances.

Some Medicare Supplement Insurance plans (also called Medigap) may cover some of the costs of foreign emergency medical care.

Custodial care

Custodial care – such as help with dressing, eating and bathing – is not covered by Original Medicare. Medicare Part A may cover these services if they are medically necessary while you are an inpatient at a skilled nursing facility.

Learn more about some of your long-term care options with Medicare.

Cosmetic surgery

Medicare does not cover cosmetic surgery unless it’s necessary to improve function of a malformed body part following an injury. Medicare also may cover some external and surgically implanted breast prostheses after a mastectomy.

Chiropractic care

Medicare Part B covers manual spine manipulation only when medically necessary. Medicare does not cover any additional chiropractic services.

Alternative treatments

Alternative care such as acupuncture and holistic treatments are not covered by Medicare.

How Medicare beneficiaries can get coverage for additional services

Medicare beneficiaries looking for coverage for the above services are not entirely out of luck. There are three Medicare options that may be used for coverage outside of or in addition to Original Medicare benefits.

  • Medicare Advantage (Medicare Part C)
    Medicare Advantage plans provide all the same benefits as Original Medicare, and many Medicare Advantage plans may also offer additional coverage for goods and services such as prescription drugs, dental, vision, hearing, wellness program memberships and more.

    Medicare Advantage plans replace your Original Medicare coverage. 
  • Medicare Prescription Drug Plans (Medicare Part D)
    A Medicare Prescription Drug Plan provides coverage exclusively for prescription medications. It can be used alongside Original Medicare or a Medicare Advantage plan that does not offer prescription drug coverage.

  • Medicare Supplement Insurance (Medigap)
    Medicare Supplement Insurance plans are used to cover some of the out-of-pocket expenses associated with Original Medicare, such as deductibles and copayments.

    Medicare Supplement Insurance plans can work alongside your Original Medicare benefits. You cannot have a Medigap plan and a Medicare Advantage plan at the same time.

Find the dental, vision, hearing and prescription drug coverage you need

Are you looking for benefits that are not covered by Medicare? Do you want a Medicare plan that covers additional services you need, including prescription drugs and other potential benefits?

A Medicare Advantage plan may provide the coverage you’re looking for. To learn more and to compare plans that are available in your area, call to speak with a licensed insurance agent.

 

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