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).
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:
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.
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.
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.
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.
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 – 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.
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.
Medicare Part B covers manual spine manipulation only when medically necessary. Medicare does not cover any additional chiropractic services.
Alternative care such as acupuncture and holistic treatments are not covered by Medicare.
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.
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, speak with a licensed insurance agent by calling TTY Users: 711, 24 hours a day, 7 days a week.
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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
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