What Medicare Does Not Cover - Medicare Consumer - Medicare Consumer

What Medicare Does Not Cover

Although Medicare covers a wide array of services, it does not cover everything. Therefore, if you do require a service that is not covered by Medicare, you may need to pay for it yourself out-of-pocket, unless you have other insurance coverage, or you are in a Medicare Advantage plan that covers the item or service. Also, even if Medicare does cover a service or an item, enrollees will oftentimes be required to pay a deductible, co-insurance, and / or a co-payment.

Some of the items and services that are not covered by Medicare include the following:

  • Custodial care (a type of long-term care)
  • Most dental care
  • Eye exams that are related to prescribing eyeglasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and exams for fitting them
  • Routine foot care


Obtaining Additional Coverage Through Medicare

While Original Medicare (Medicare Parts A and B) may not cover certain services, there is an alternate method of obtaining additional coverage. This is through opting for Medicare coverage through Medicare Part C – also known as Medicare Advantage.

A Medicare Advantage plan is an alternative way for Medicare enrollees to receive Part A and Part B coverage. These plans, offered by private insurance companies, are required to provide all of the same benefits that are included in Original Medicare – however, they will typically also include additional coverage such as dental and vision care. Many Medicare Advantage plans may also offer coverage such as wellness benefits and preventive benefit options.

Another way to obtain additional coverage that is not offered via Original Medicare is to purchase a Medicare Supplement insurance policy. These plans, also known as Medigap insurance, can help to fill in the “gaps” in coverage that are left by Medicare such as the payment of deductibles, co-payments, and / or co-insurance that would otherwise need to be paid out-of-pocket by a Medicare enrollee. Depending on the policy that is chosen, these plans can also pay out additional benefits, too, such as coverage during foreign travel emergencies.


How to Determine Whether Medicare Covers a Test, Item or Service

In order to determine whether or not Medicare will cover a particular test, item, or service, it is important to discuss the situation with your doctor and / or other health care provider prior to moving forward with a procedure or the purchase of medical equipment. This is because the cost can be dependent on a number of different factors such as any other insurance that you may have, as well as where the procedure is performed and / or where the equipment is purchased.

You may also be able to determine whether or not an item or service will be covered by Medicare by going to Medicare’s website and typing in the name of the item, test, or service here: https://www.medicare.gov/coverage/your-medicare-coverage.html. This will provide you with the additional information that you need regarding your Medicare coverage. For additional information, you may also contact Medicare directly.

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