What Does Medicare Not Cover
Medicare does not cover services or supplies that are medically unreasonable or unnecessary to diagnose and treat a patient’s condition. (CMS.gov page 5) For example, Medicare does not cover:
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- Long-term care – the daily living and medical care you get in an assisted-living or nursing home.
- More than 20 days in a Skilled Nursing Facility – however, your Medigap Plan may pay for up to 100 days.
- Greater than 90 days in a hospital if no lifetime reserve days – otherwise, add your remaining reserve days out of 60.
- More than six months of hospice care
Medicare Coverage Outside the United States
There are particular cases when Medicare does provide foreign travel coverage outside the United States. If you do not meet these specific circumstances, Medicare will not pay for services outside the US. However, you can get foreign travel emergency benefits with a Medicare Supplement Plan, such as Medigap Plan G.
Personal Comfort Items and Services
Medicare does not cover personal comfort items such as radios and televisions. Furthermore, Medicare does not provide comfort services such as beauty and barber services. However, you can request such items and services, and the charge may not exceed the typical cost.
When you can not perform these services yourself, Medicare may cover shaves, haircuts, and shampoos.
Annual Physical Checkups
Medicare does not cover annual physical checkups. However, Medicare does cover Annual Wellness Visits. A physical exam is more comprehensive than a wellness visit and could cost you $400 or more!
Dental, Fitness, Hearing, Vision, and Transportation
Medicare doesn’t provide dental, fitness programs, hearing, vision, and transportation (non-emergency) services. However, you can get these Medicare Advantage Benefits with a MA Plan. If you need eyeglasses, hearing aids, or dental care, consider changing your MA Plan.
Medicare doesn’t provide vision service unless it’s medically necessary. For example, you can get eye exams when you have diabetes or glaucoma tests if you are at high risk for glaucoma.
Cosmetic Surgery
Medicare doesn’t cover cosmetic surgery, which includes any procedure to improve the patient’s appearance. However, Medicare may cover cosmetic surgery to make repairs on an accidental injury. Furthermore, Medicare may also cover surgery to improve the functioning of a malformed body member. Examples of covered cosmetic surgery:
- Treatment of severe burns
- Repairing the face after a serious accident
- Surgery for therapeutic purposes that incidentally has cosmetic appeal
Medicare May Not Cover
Medicare may not cover services or supplies when a doctor or other health care practitioner deems them not medically necessary. Services that Medicare may not cover:
- Allergy Shots – immunotherapy that desensitizes you of particular allergens such as grasses, pollens, and trees
- Acupuncture – only covers chronic lower back pain
- Chiropractic Services – limits coverage to adjustment of the spine to correct a subluxation
- Foot care – many exceptions apply – such as diabetic foot care, which may cover therapeutic shoes or inserts
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