What Medicare Coverage Doesn’t Cover?

Medicare provides important health coverage for Americans 65 and older, but it doesn’t cover everything. Learning what is and isn’t covered by Medicare can help you plan for additional coverage if needed. This article outlines key things Medicare does and doesn’t cover.

Medicare Part A and Part B Coverage

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Medicare Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment.

Together, Original Medicare coverage (Parts A and B) covers a significant portion of medical costs, but not 100%. There are gaps in coverage you may need to supplement.

Prescription Drugs

One major gap is prescription drug coverage. Medicare Part D provides prescription drug coverage, but it is optional. Medicare Parts A and B do not cover prescription medications. You must enroll in a separate Part D Plan to get Medicare drug coverage.

Routine Dental, Vision, and Hearing Care

Original Medicare does not cover routine dental cleanings, fillings, dentures, most eye exams related to prescribing glasses, and hearing exams. Some exceptions apply, like dental care required for certain covered medical services.

To get dental, vision, and hearing coverage, you need to enroll in a Medicare Advantage Plan (Part C) that offers these benefits or purchase separate supplemental insurance.

Long-Term Care

Medicare does not cover long-term care or custodial care in nursing homes or at home. To get help with long-term care costs, you would need private long-term care insurance or qualify for Medicaid.

Travel Outside the U.S.

Original Medicare does not offer coverage for medical care or supplies received outside the U.S. You would need to purchase a Medicare Supplement or Advantage Plan with foreign travel emergency benefits or a separate travel insurance policy.

Key Medicare Exceptions

There are a few exceptions where Medicare Part B may help cover:

• Eye exams related to medical conditions like glaucoma or diabetes
• Eyeglasses after cataract surgery
• Some dental services when medically necessary
• Cost of hearing aids (but not exams)

Supplementing Medicare

Options to supplement Original Medicare gaps include:

• Medicare Supplement (Medigap) plans
• Medicare Part C (Medicare Advantage Plans)
• Medicaid benefits for those who qualify
• Private insurance (dental, vision, hearing, long-term care)

Knowing what Medicare does and doesn’t cover can help you plan ahead for any additional coverage needs in retirement. Speak with a Medicare insurance agent or trusted advisor if you need help navigating your options.

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 Senior Health Advocates a Call at (386) 222-3030. 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 is Original Medicare?

 Original Medicare refers to the traditional Medicare program that includes Part A (hospital insurance) and Part B (medical insurance).

What does Medicare Part B cover?

 Medicare Part B covers medical services and supplies that are medically necessary to treat or diagnose a medical condition. This includes doctor’s visits, outpatient care, preventive services, and some medical equipment.

Does Medicare Part B cover dental care?

 No, Medicare Part B does not cover routine dental care, such as cleanings, fillings, or dentures. However, it may cover dental services that are related to a covered medical procedure.

Does Medicare Part B cover eye exams?

A: Medicare Part B generally does not cover routine eye exams for eyeglasses or contact lenses. However, it may cover eye exams that are medically necessary to diagnose or treat an eye condition.

Can Medicare Part B cover hearing aids?

 No, Medicare Part B does not cover hearing aids or routine hearing exams. However, there may be other coverage options available, such as Medicare Advantage Plans or private insurance.

What services are covered by Original Medicare?

 Original Medicare covers a wide range of services, including inpatient hospital care, skilled nursing facility care, doctor’s visits, outpatient care, preventive services, and some medical equipment.

How do I file a Medicare claim?

A: To file a Medicare claim, you need to complete a Medicare Claim form and submit it along with any necessary documentation to the Medicare claims processing center. You can also ask your healthcare provider to submit the claim on your behalf.

Does Medicare cover prescription drugs?

A: Medicare Part B provides limited coverage for certain prescription drugs that are administered in a doctor’s office or outpatient setting. However, for most prescription drugs, you will need to enroll in a separate Medicare Part D prescription drug plan.

Can Medicare Advantage Plans cover services that Medicare does not cover?

 Yes, Medicare Advantage Plans may offer additional benefits that are not covered by Original Medicare. These can include dental care, vision care, hearing aids, and prescription drug coverage.

How do I sign up for Medicare?

You can sign up for Medicare by contacting the Social Security Administration or visiting their website. The enrollment period is typically seven months long, starting three months before your 65th birthday.