What Does Medicare Not Cover?

Although Medicare covers a fairly extensive list of services, it also leaves a number of gaps in its coverage that it is important for enrollees to be aware of. Therefore, upon enrolling in Medicare, it is a good idea to have an understanding of where you will be required to pay out-of-pocket for services that are used.

Services Not Covered By Medicare

The services that are not covered by Medicare include the following:

  • Personal / Custodial Care – Personal or custodial care can include assistance with basic activities of daily living such as bathing, dressing, and toileting – unless the recipient is homebound and is receiving skilled care services. Nursing home care is also excluded from Medicare coverage, except for care that is received in a skilled nursing facility by a Medicare enrollee who has met strict eligibility criteria).
  • Preventive Care – Certain preventive care is also excluded from Medicare coverage, including routine foot care.
  • Most Vision Care – Most eye care is not covered by Medicare either. This includes coverage for eye exams for the prescribing and the fitting of eyeglasses, as well as for the actual eyeglasses themselves, other than when following cataract surgery.
  • Most Dental Care – Most dental care is not included in Medicare’s covered services.
  • Hearing Aids – Medicare does not cover the charges for obtaining hearing aids, nor for the exams that take place for the prescribing or the fitting of hearing aids. One exception to this is for the implants that are used to for the treatment of severe hearing loss in certain cases.
  • Alternative Medicine – Alternative medicine, which includes experimental treatments and procedures, chiropractic services (other than when manipulation of the spine is medically necessary for fixing a subluxation), and acupuncture is also excluded from coverage by Medicare.
  • Non-Medical Services – Non-medical services, which include items such as hospital telephones and televisions, private hospital rooms, and copies of x-rays are not included in Medicare’s covered services.
  • Housekeeping Services – Medicare does not cover the cost of housekeeping services such as meal preparation or shopping to help an enrollee to remain in their home. One exception to this is house cleaning, which may only be covered if the Medicare enrollee is receiving hospice care.
  • Most Non-Emergency Transportation – Although Medicare will cover emergency transportation, it will not provide coverage for transportation that is considered to be non-emergency in nature. This includes ambulette services.
  • Cosmetic Surgery – Charges for cosmetic surgery are also not covered by Medicare, unless the surgery is needed to improve the function of a malformed part of the patient’s body.

In addition to the above, Medicare also does not cover most care that is received outside of the United States. Likewise, even with the services that are covered by Medicare, oftentimes 100% of the actual expenses are not paid for. This is due to Medicare’s copayments and deductibles – and in some cases, this could require the Medicare enrollee to incur a significant out-of-pocket charge.

How to Obtain Additional Coverage for Your Health Care Services

In order to obtain coverage for services that are not covered by Medicare, there are options available. These include:

  • Medicare Supplement Insurance – Medicare Supplement insurance, often referred to as Medigap, is a type of insurance coverage that can be purchased to fill in some of the “gaps” that are left by Medicare. This insurance can pay for Medicare’s copayments, deductibles, and coinsurance amounts. There are ten different Medicare Supplement insurance policies to choose from, and these plans range from basic to highly comprehensive coverage.
  • Medicare Advantage – Medicare Advantage, also referred to as Medicare Part C, is another way to obtain some coverage for services that Medicare does not provide. These plans must provide at least the same set of benefits that is offered through Medicare Parts A and B (Original Medicare), however, they may have differing costs, rules, and other restrictions. In addition, some of these plans may also provide additional benefits such as dental or vision care services. Medicare Advantage plans work in a similar fashion to an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization). They also typically have annual limitations on patients’ out-of-pocket cost, which can essentially protect participants from excessively high health care expenses.
  • Medicare Part D – Medicare Part D is a stand-alone private drug plan. For those who have Medicare Parts A and B and want additional coverage for prescription drugs, they can do so by obtaining Medicare Part D. There are a number of different Part D plan options, each with differing premium costs and drugs that are covered.
  • Medicaid – For those who qualify based on low income and assets, Medicaid may be available to help pay for certain services such as transportation to doctor’s appointments and some long-term care related coverage.

Prior to applying for any additional services, it is important to determine what may or may not be needed. This way, you can better anticipate whether or not you will be paying premiums for coverage that you might not likely use now or in the future.

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