Updated: Sep 2
Many seniors are excited to make the transition from private health insurance to Medicare. When they start looking into what is covered by original Medicare (Part A and Part B) compared to their private plans, however, they find coverage gaps that most will want to fill if they are able. It’s best to understand up front what isn’t covered under original Medicare so kupuna can decide whether a Medicare Advantage plan makes more sense for them or whether certain add-ons will be needed.
10 medical services not covered by Medicare
Seniors who need help with daily self-care, chores or errands will be disappointed to find out that personal care needs are not covered by original Medicare.
Long-term care (custodial care)
While Medicare will pay for a temporary stay at a nursing care facility after a hospital stay of three or more days, fees kick in after 20 days and coverage stops for stays that last longer than 100 days.
Most dental care
Dental care is not considered part of basic health care and as a result, routine cleanings, fillings, dentures and other dental care needs are not covered by Medicare, except in rare circumstances where dental services were received in a hospital to deal with an emergency.
Eye exams for glasses prescriptions
Vision checks for people with overall healthy eyes looking for a glasses or contact lens prescription are not covered by Medicare. Enrollees may be able to get coverage for exams and tests for specific eye health conditions under Medicare Part B and a simple vision test may be offered as preventative care during the first 12 months after a senior signs up for Medicare Part B.
Glasses and contacts
Medicare doesn’t cover the purchase of glasses or contact lenses except for the cost of one pair of glasses or a set of contact lenses after cataract surgery with the implantation of an intraocular lens. (Medicare does pay for the cataract surgery).
Hearing aids and fitting exams
Despite the fact that many older Americans need hearing aids to hear properly, Medicare does not cover the hearing exam needed to choose and fit a hearing aid. It also doesn’t pay for the hearing aid itself.
Acupuncture and massage
Acupuncture and massage are not generally covered by Medicare, though the plan will cover medically necessary chiropractic adjustments.
Medicare doesn’t cover many types of cosmetic surgery but it will usually cover cosmetic surgery needed because of an injury or deformity. A good example is breast cancer survivors. Medicare will cover the cost for a breast prosthesis after a mastectomy.
Routine foot care
Medicare will not cover the costs for routine foot care like removing callouses and corns and nail and foot cleaning. Foot exams and treatments are sometimes covered for those with diabetes or other health conditions and medically necessary podiatrist care is covered under Medicare Part B.
Medical treatment received outside the U.S.
Apart from a few exceptions, Medicare does not cover medical treatment received outside of the country. A common exception is for medical care received while aboard a ship in U.S. territorial waters.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.