Original Medicare consists of Part A and Part B and provides broad coverage for healthcare services once you turn 65. But Medicare does not cover 100% of medical costs. There are some significant gaps in Original Medicare coverage that beneficiaries pay for entirely out-of-pocket.
In this article, we’ll outline the 6 primary categories of healthcare services that are not covered by Medicare. Understanding these Medicare coverage limitations is key to planning for certain out-of-pocket medical expenses in retirement.
1. Routine Dental Care
One major gap in Original Medicare is coverage for dental care. Medicare does not cover routine dental services like:
- Dental exams, teeth cleanings, x-rays
- Fillings, crowns, bridges, dentures
- Tooth extractions, root canals
- Dental implants
- Orthodontia like braces
- Dental supplies
Medicare only pays for very limited dental care such as an oral examination prior to kidney transplant or extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease.
Medicare beneficiaries must pay all costs for routine dental visits and procedures out of pocket. Those expenses can easily run hundreds or thousands of dollars per year for many retirees.
Having dental insurance or enrolling in a Medicare Advantage Plan with dental coverage can help offset those costs. But with Original Medicare you receive no assistance for customary dental care.
2. Routine Vision Care
In the same way that dental care is not addressed, Original Medicare also provides no coverage for routine vision services like:
- Eye exams for glasses/contacts
- Glasses or contact lenses
- Contact lens fitting
- Eyeglass frames
- Vision hardware upgrades
Medicare does cover certain medical vision services required due to illness or injury, like:
- Eye exams to diagnose medical eye conditions
- Cataract surgery
- Corneal transplants
- Treatment for glaucoma
- Diabetic retinopathy screening
But Medicare beneficiaries must pay routine vision costs to get glasses or contacts out of pocket. Vision insurance plans and some Medicare Advantage Plans can provide coverage for routine eye care and eyewear.
3. Hearing Aids
Hearing aids and exams to fit hearing aids are not covered by Original Medicare.
This means 100% of costs for hearing aids and hearing aid fitting exams are paid by beneficiaries themselves. Typical costs for hearing aids run $2,000 – $4,000 per device.
Medicare does cover some hearing-related services including:
- Hearing tests to diagnose medical conditions
- Cochlear implant surgery
- Auditory rehabilitation training
- Diagnostic hearing exams
But hardware costs for hearing aids are not covered. Some Medicare Advantage Plans may or do offer hearing aid benefits. And some new over-the-counter hearing aids are now available without a prescription at more affordable price points.
4. Most Care Outside the U.S.
When traveling abroad outside the United States, Medicare typically does not cover any medical care you receive.
The only exceptions are for medical emergencies in circumstances where it would have been unreasonable or unadvisable to avoid getting care before returning to the U.S.
So routine doctor visits or planned procedures abroad are not covered by Medicare. You would need separate travel health insurance for broader international medical coverage.
Within the U.S. including territories like Puerto Rico, Original Medicare covers you for medically-necessary care. But healthcare obtained in foreign countries is generally excluded except for very limited emergency scenarios.
5. Long-Term Care
Medicare also does not cover what’s known as “custodial care” – long-term care provided in nursing homes, assisted living facilities, or at home to assist with activities of daily living.
Long-term care helps provide assistance for daily tasks like:
- Eating
- Bathing
- Dressing
- Using the bathroom
- Meal preparation
- Housekeeping
Medicare only pays for skilled nursing care or rehabilitative care services provided after a hospital stay, and only for a limited period. Ongoing long-term care costs are not covered.
Beneficiaries pay for custodial long-term care entirely out of pocket unless they have long-term care insurance or qualify for Medicaid. With 10% of people over 65 expected to need nursing home care at some point, this coverage gap is concerning.
6. Most Cosmetic Procedures
Finally, Original Medicare does not provide coverage for cosmetic or reconstructive surgery that is purely for aesthetic reasons rather than fixing functional impairments.
Examples of cosmetic procedures not covered include:
- Face lifts
- Liposuction
- Nose reshaping
- Eyelid surgery
- Breast enlargement
- Laser skin resurfacing
- Botox injections
However, Medicare may cover cosmetic procedures required due to illness or injury, such as breast reconstruction after a mastectomy for cancer treatment.
Only procedures deemed medically necessary are covered. Surgeries and treatments solely for cosmetic reasons must be paid entirely out of pocket by beneficiaries.
How to Supplement Medicare for Non-Covered Services
To help cover healthcare costs in areas where Original Medicare falls short, beneficiaries have a few options:
- Medicare Advantage – Many plans include some dental, vision, hearing and fitness benefits
- Medigap – Helps pay copays, deductibles and coinsurance
- Individual insurance – Such as dental insurance or vision plans
- Health savings accounts – Can reimburse qualified out-of-pocket costs with tax-free funds
- Caregiving support – Assistance from family can offset some costs
Understanding gaps in Medicare coverage allows you to effectively Supplement those needs through private insurance, Medicare Advantage, HSAs or other means.
Does Medicare Cover Everything?
While Medicare covers a wide range of medically necessary healthcare services once you turn 65, it does not provide 100% comprehensive medical coverage. Important gaps like dental, vision, hearing and long-term care mean many beneficiaries face significant out-of-pocket costs.
Knowing the limitations of Original Medicare allows you to plan and budget for those uncovered expenses through supplemental private insurance, Medicare Advantage, health savings and other tools.
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Think65 a Call at (719) 301-1220. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
FAQS
What are the 6 things Medicare does not cover?
Medicare does not cover long-term care, dental care, eye exams for glasses, dentures, cosmetic surgery, or acupuncture.
Does Medicare Part A cover prescription drugs?
No, Medicare Part A does not cover prescription drugs.
What is the difference between Original Medicare and Medicare Advantage Plans?
Original Medicare is the traditional fee-for-service program offered by the government, while Medicare Advantage Plans are offered by private insurance companies and provide additional benefits beyond what Medicare covers.
Does Original Medicare cover the cost of prescription drugs?
No, Original Medicare does not cover the cost of prescription drugs.
What is Medicare Part D prescription drug coverage?
Medicare Part D is a prescription drug coverage program offered by private insurance companies that works in conjunction with Medicare Parts A and B.
Are routine vision care and eye exams covered by Original Medicare?
No, routine vision care and eye exams are not covered by Original Medicare.
Does Medicare cover the cost of long-term care?
Medicare generally does not cover the cost of long-term care.
Can Medicare Advantage Plans offer prescription drug coverage?
Yes, many Medicare Advantage Plans include prescription drug coverage.
What does Medicare Part B cover?
Medicare Part B covers medical services and supplies that are necessary to treat or diagnose a medical condition.
Do Medicare Supplement Plans cover the costs not covered by Original Medicare?
Yes, Medicare Supplement Plans, also known as Medigap Plans, help cover the costs not covered by Original Medicare.