10 Things Medicare Does Not Cover: What You Need to Know

Medicare provides essential healthcare coverage for millions of Americans, but there are significant gaps in its coverage. Many services and treatments that beneficiaries assume are included may not be covered, leading to unexpected out-of-pocket costs. Understanding these exclusions can help individuals plan effectively for additional coverage or alternative options.

1. Long-Term Care (Custodial Care)

Medicare does not cover long-term custodial care in nursing homes, assisted living facilities, or at-home care if it is not medically necessary. Medicaid or private long-term care insurance policies are often required to cover these expenses.

2. Dental Care and Dentures

Routine dental exams, cleanings, fillings, extractions, and dentures are not covered under Original Medicare. Beneficiaries must seek standalone dental insurance or Medicare Advantage plans that include dental benefits.

3. Vision Care and Eyeglasses

Routine eye exams, prescription glasses, and contact lenses are not included. Medicare only covers vision services related to specific conditions like cataracts or glaucoma. Many seniors opt for private vision insurance or discount plans to cover these expenses.

4. Hearing Aids and Exams for Fitting

Medicare does not pay for hearing aids or related exams. Given the high cost of hearing aids, many individuals turn to private insurance, Medicare Advantage plans, or organizations offering financial assistance.

5. Alternative Medicine and Acupuncture

Medicare excludes alternative treatments like acupuncture, naturopathy, and holistic therapies. However, acupuncture is covered for chronic lower back pain under specific conditions.

6. Cosmetic Surgery

Elective cosmetic procedures, including facelifts, Botox, and liposuction, are not covered. Medicare only provides coverage when surgery is deemed medically necessary, such as reconstructive surgery after trauma or mastectomy.

7. Prescription Drugs (Standalone Coverage)

Original Medicare does not cover outpatient prescription drugs. Beneficiaries must enroll in Medicare Part D or a Medicare Advantage plan with drug coverage to help manage medication costs.

8. Routine Foot Care

Regular foot care, such as trimming nails, treating corns, or calluses, is not covered unless it is related to diabetes or another qualifying medical condition. Podiatric services for minor foot issues typically require out-of-pocket payments.

9. Overseas Medical Care

Medicare coverage is generally limited to the United States. Medical emergencies abroad are not covered unless under very restricted circumstances. Travel insurance with medical coverage is highly recommended for those traveling internationally.

10. Personal Care Assistance

Assistance with daily activities such as bathing, dressing, and eating is not covered unless it is part of a skilled nursing service. Individuals needing ongoing personal care must rely on Medicaid, long-term care insurance, or personal funds.

Medicare Coverage Gaps: Planning Ahead

Since Medicare does not cover these services, beneficiaries should explore supplemental coverage options, including:

• Medicare Advantage (Part C): Some plans offer vision, dental, and hearing coverage.

• Medigap (Medicare Supplement) Plans: Helps cover out-of-pocket expenses Medicare does not pay for.

• Long-Term Care Insurance: Provides financial protection for extended care needs.

• Health Savings Accounts (HSAs): Can be used for medical expenses if enrolled in a high-deductible health plan before Medicare.

Understanding Medicare’s limitations is crucial for avoiding unexpected expenses. By supplementing Medicare with additional coverage, individuals can better manage healthcare costs and secure the care they need. Reviewing all options and planning for these gaps ensures a more comprehensive approach to healthcare in retirement.

Steven Rukhman
SRB Insurance Services // [email protected]

I am a local, licensed and trained independent insurance agent. I am certified with many top Medicare Advantage, Prescription Drug and Medicare Supplement insurance plan carriers. I represent most major companies with a Medicare contract and am qualified to answer any questions you may have.