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10 Things Original Medicare Doesn’t Cover

What does Medicare not cover? You may be surprised that many necessities are not covered under Medicare. Learn which 10 items often must be paid out-of-pocket.

Older man speaking with a pharmacist at a pharmacy counter

The ins and outs of Medicare can be complicated. Let’s start with the basics. Medicare is divided into four separate components. Parts A and B are considered Original Medicare and are provided by the government. Part C, also known as Medicare Advantage, and Part D prescription drug plans are offered through private insurers to help fill the gaps in services that are not provided through Parts A and B. Original Medicare, Parts A and B, are designated for hospitalization and outpatient services (like doctor visits), respectively. But you can imagine there are many things an older adult would need that don’t fall into those categories.

Here are 10 health services and medical supplies that are typically not covered by Original Medicare, Parts A and B, but may be covered by an all-in-one Medicare Advantage plan:

1. Hearing aids, exams, and related accessibility services

Although hearing loss becomes more common as we age, Original Medicare does not cover hearing services such as hearing aids and exams. With Original Medicare, hearing aids and other accessibility-related expenses that increase the quality of life for the deaf and hard of hearing need to be paid out-of-pocket. However, Medicare Advantage plans often cover hearing benefits as part of a comprehensive plan package.

2. Eyeglasses and eye exams

Original Medicare does not cover vision services and ongoing needs. Similar to hearing services, glasses, contact lenses, and eye exams must be paid out-of-pocket if you have Original Medicare. The only exception to this rule is if you are diagnosed with cataracts after your eye exam. Original Medicare will cover one pair of glasses or contacts if you have had cataract surgery.

The importance of eye health leads many people on Medicare to consider switching to a Medicare Advantage plan, which often includes extras like vision benefits.

3. Routine foot care

Some podiatrist visits are covered under Medicare Part B, but routine foot care, such as callus removal, which is more frequently needed by older adults, is not. However, treatment and foot exams for diabetic nerve damage, and foot injuries, such as heel spurs and bunions, are covered.

4. Cosmetic procedures

Like most private health insurance, Original Medicare does not cover elective cosmetic surgeries like facelifts or liposuction. The only coverage for cosmetic procedures that Medicare allows is reconstructive surgery in the event of a car accident or similar grievous injury.

5. Alternative care and therapeutics

Chiropractic care, acupuncture, and massage therapy frequently help people with chronic pain when standard medical procedures like drugs and surgeries have failed.

While coverage for these therapies varies with private plans, Original Medicare typically doesn’t cover a majority of chiropractic services. Medicare Part B will pay for one manual spine manipulation by a chiropractor if the spine is dislocated from its normal position, but routine chiropractic services are not covered.

Medicare only pays for up to 20 covered acupuncture sessions per year for enrollees who have lower back pain for 12 weeks or more on average. For all other ailments, however, acupuncture is not covered.

Massage therapy is not covered at all, even if recommended as part of a pain management plan. Only physical therapy and occupational therapy are covered under Medicare, if prescribed by a physician.

6. Long-term care in a nursing home

Medicare covers temporary stays in rehabilitation facilities, such as inpatient physical therapy after a hip replacement or other major surgery. Assisted living and nursing home care, however, are not covered under Medicare.

7. Mobility aids that are not purchased from a Durable Medical Equipment Supplier (DME)

If a doctor prescribes a mobility aid for a permanent condition to assist with walking, such as a walker or wheelchair, these are covered by Original Medicare. Medicare enrollees can purchase or rent mobility aids like canes, walkers, scooters, and manual and motorized wheelchairs from a durable medical equipment supplier (DME).

Medical supplies purchased from the DME are subject to Medicare’s 20% coinsurance and any Part B deductible that still applies. This means motorized wheelchairs and durable walkers can cost significantly more through a DME than through online medical suppliers or second-hand retailers. Even with Medicare coverage, many people opt to pay for these items out-of-pocket.

8. Home modifications for accessibility

While mobility aids are covered under Original Medicare if purchased through a DME supplier, this is not true of retrofitting your home to make it wheelchair-accessible by widening doorways and replacing stairs with ramps.

Even if a doctor suggests making these changes to your home, Medicare doesn’t cover retrofitting expenses under the DME benefit.

9.  Routine dental care and dentures

Original Medicare doesn’t cover dental expenses, such as dental exams, dentures and routine dental procedures. These types of services would need to be paid out-of-pocket or with a separate dental plan. Or you can also consider enrolling in a Medicare Advantage plan where dental care is usually covered.

10. Non-emergency medical care overseas

While emergency care is covered by Medicare (Part A) outside of the United States, non-emergent medical care (Part B) is not. So, if you plan on retiring in another country, you may choose to opt out of Medicare and enroll in a health plan in that country. Otherwise, medical care overseas requires supplemental coverage or travel insurance. If you move back to the United States, you would need to re-enroll in Medicare and may be subject to Part B penalties. You can also consider switching from Original Medicare to a Medicare Advantage plan. Medicare Advantage plans often include travel programs extending your coverage when you’re traveling within the U.S. and abroad.

How to make sure you’re covered

Medicare enrollees seeking additional coverage for services and items on this list often turn to Medicare Advantage plans and supplements such as Medigap. Medicare Advantage plans can include coverage for things like prescription drugs, hearing, vision, dental and more.

Contact us any time and a Baylor Scott & White Health Plan Licensed Insurance Agent can answer any question you have about Medicare.

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