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What Does Medicare Not Cover?

Discover what Medicare does not cover including the most common out-of-pocket costs: dental, hearing, and vistion.

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Original Medicare — parts A and B — doesn’t cover it all. With Medicare Part A you’re covered for most hospital inpatient services. And Medicare Part B is outpatient medical coverage that takes care of medically necessary services and supplies. But what does Medicare not cover?

Of course, when it comes to Original Medicare, you’ll need to pay your deductible and any applicable coinsurance. These amounts change from year to year, so be sure you have the latest figures when planning your health care.

There are some exceptions, but common services Medicare typically doesn’t cover include:

In addition to the items and services listed above, Medicare doesn’t pay for anything your doctors consider medically unreasonable and unnecessary services and supplies to diagnose or treat your condition. Medicare also doesn’t cover hospital services that exceed length-of-stay limitations, and it only covers the first 20 days in a Skilled Nursing Facility.

If you’re in need of a service not covered by Medicare, you can pay out of pocket or obtain another insurance plan or Medicare policy that can help pay for your needs.

Dental Care Coverage

KFF.org found that nearly half of all Medicare beneficiaries, or about 24 million people, have no dental coverage. The same study found that average out-of-pocket spending for those who had dental care was $874 per year.

Even common procedures like cleanings, fillings and extractions and dental supplies like dentures are not covered by Original Medicare. Of course, if you’re an inpatient in a hospital, Medicare Part A may cover any necessary dental services that may have contributed to your stay.

This means you could end up paying 100% out of pocket for most of your dental care needs.

What Dental Services Are Excluded From Medicare Coverage?

Here are some common dental care services that Medicare may not cover:

  • Preventative care (e.g., routine oral exams, cleanings, fluoride treatments, X-rays)

  • Restorative services (e.g., fillings)

  • Endodontics (e.g., root canals)

  • Periodontics (e.g., scaling and root planing)

  • Prosthodontics (e.g., crowns, bridges, dentures, dental implants)

  • Oral surgery

Hearing Coverage

A KFF.org study showed that while 65% of Medicare beneficiaries said they have hearing difficulties, only 14% of them actually use a hearing aid. Even fewer — 8% — reported using hearing services within the past year. And whereas half of the beneficiaries who used hearing services spent less than $60 out of pocket, the top 10% actually spent $3,600 or more out of pocket.

This could be due to the high cost of hearing aids. Let’s talk about what out-of-pocket hearing costs you might encounter.

What Hearing Services Are Excluded From Medicare Coverage?

On average, a pair of hearing aids can cost about $4,000 . Unfortunately, Medicare does not cover hearing aids.

So, with Original Medicare, you’ll pay 100% of the cost for:

  • Hearing aids

  • Any exams you may need to get fitted for hearing aids

Vision Care Coverage

Vision care coverage varies from service to service. While routine services may not be covered by Medicare, certain services for chronic conditions can be covered.

KFF.org found that more than a third , or 20.2 million, Medicare beneficiaries reported difficulty with their vision. With the lack of Medicare coverage for routine vision care,
out-of-pocket costs can stack up for the millions of beneficiaries with eyesight issues. In fact, KFF.org’s study found that average out-of-pocket spending for vision care was about $230 per year.

What Vision Services Are Excluded From Medicare Coverage?

Some common vision care services that Medicare may not cover include:

  • Routine eye exams

  • Eyewear (e.g., eyeglasses, contacts)

Other Options: Filling the Gaps in Your Medicare Coverage

While Medicare parts A and B don’t cover everything, there are options to take care of some or all of your out-of-pocket costs.

Medicare Part C, or a Medicare Advantage plan — offered by Medicare-approved private companies — often covers items and services not covered under Original Medicare.

Medicare Part D plans can save you money on prescription drugs.

A Medicare Supplement, or Medigap plan, can also help cover some of the services not covered under Original Medicare. Just remember, you won’t be able to enroll in or use a Medigap plan if you’re also under a Medicare Advantage plan.

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.