The Medicare program provides fantastic coverage options for Medicare beneficiaries. However, many are surprised when they discover that it doesn’t cover everything. Below we’ll review five items or services that Medicare doesn’t cover. As we go through, we’ll explain ways that you can secure coverage for items and services not covered by Medicare.

5 Services Not Covered By Medicare

As mentioned above, Medicare doesn’t cover everything. Original Medicare only covers items and services that are considered medically necessary.

For example, Medicare Part A covers Inpatient hospital stays, hospital services, and skilled nursing facilities but not nursing home custodial services.

Likewise, Medicare Part B covers outpatient medical services, healthcare provider visits, and durable medical equipment but not dental, vision, or hearing coverage.

Medicare excludes more than five items and services, but today we’ll discuss the five most significant.

#1 Routine Dental Coverage

Medicare covers dental services considered medically necessary. However, that doesn’t include much. Original Medicare coverage excludes routine dental care.

Services that maintain oral health, such as cleanings, X-rays, and extractions, aren’t covered. Coverage for routine dental, including dentures and, in some cases, dental implants, can be obtained through a Medicare Advantage plan or stand-alone dental health insurance.

There are many benefits to routine dental care and checkup, including early detection of medical conditions. Still, Medicare doesn’t consider it medically necessary.

#2 Routine Vision Coverage

While Medicare will cover services performed by an Ophthalmologist for medical conditions such as glaucoma and cataract surgery, coverage for eye exams, contact lenses, and eyeglasses is generally not covered.

There are a few exceptions. Suppose you’re seeking coverage for routine vision services. In that case, you’ll need a vision program or Medicare Advantage plan that offers a vision benefit.

#3 Custodial Care Services

Medicare coverage includes medical services in long-term care facilities, assisted living facilities, nursing homes, home care, and hospice care.

However, Medicare doesn’t have coverage for personal and custodial care isn’t covered by Medicare. Personal and custodial care includes activities of daily living such as personal hygiene, bathroom needs, and feeding.

Additional items related to these facilities and care types that aren’t covered include homemaker services, room, and boarding costs.

#4 Routine Hearing Coverage

Hearing coverage isn’t medically necessary but dramatically impacts the quality of life for Medicare beneficiaries. As with vision coverage, if it’s for a medical condition and medically necessary, Medicare benefits may cover hearing services.

However, this is the exception, not the standard practice. Original Medicare doesn’t provide hearing aids and exam coverage, but many Medicare Advantage plans offer hearing benefits.

#5 Alternative Medicine

Recently Medicare has begun to cover acupuncture as an approved treatment for lower back pain. But other forms of alternative medicine are not covered. Alternative medicine includes experimental treatments and chiropractic services, except for subluxation of the spine.

Additional items and services not covered by Medicare

While Medicare health services exclude the items and benefits listed above, other notable exclusions include certain preventive services like routine foot care or cosmetic surgery.

Medicare Advantage Plans May Cover Excluded Services

Some of the excluded benefits may have some coverage offered by specific Medicare health plans. Medicare Part C combines Medicare benefits into one program called Medicare Advantage. These insurance plans must cover all items and services afforded by Medicare Part A and Part B.

Still, they can include additional plan extras not covered by Medicare. These plan extras can help cover some of the Medicare excluded items listed above. Medicare Advantage plans cover not only medical care, but most include prescription drug coverage as well.

FAQs

Does Medicare cover Botox?

Medicare covers botox for medical conditions such as migraines, and the FDA has approved Botox injections for specific health conditions. There isn’t any coverage for Botox for cosmetic services.

Will Medicare pay for eyeglasses after cataract surgery?

Medicare Part B covers cataract surgery and will provide one pair of corrective lenses and a standard frame after surgery to repair cataracts. Medicare will only cover eyeglasses for cataracts from Medicare-approved suppliers.

Will Medicare cover my podiatrist?

Medicare will cover podiatry services considered medically necessary. However, Medicare does exclude some preventive services for podiatry.

Does Medicare cover dental implants?

Medicare doesn’t cover dental work. However, some Medicare Advantage plans will include dental coverage. Most Medicare Advantage plans won’t cover dental implants. However, in some areas, a few insurance companies, such as Aetna, have Part C programs that include implant coverage.

Can I get hearing aids through Medicare?

Medicare doesn’t provide coverage for hearing aids, batteries, or hearing exams. You can receive hearing benefits through many Medicare Advantage plans.

Medicare Part C plans can provide coverage for hearing exams and an annual allowance to purchase hearing aids. You can even use the Medicare Advantage plan’s over-the-counter benefits can be used to buy batteries for your hearing aids.

Getting Coverage for Items and Services Not Covered by Medicare

Indeed, Medicare doesn’t include everything. However, you can find coverage for many excluded items through a Medicare Advantage plan. We can help review the programs available in your area, check your medications and doctors to ensure the programs fit your needs and help with enrollment. For help, simply fill out our online request form or give us a call.

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by Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.