Healthcare Services Medicare: If you have Medicare, it’s easy to assume that most of your healthcare costs will be covered. After all, Medicare provides important health insurance benefits for millions of Americans.
But Medicare does not cover every healthcare service or medical expense.
Some services are excluded from Original Medicare altogether, while others may only be covered under specific circumstances or through a Medicare Advantage plan. Knowing what Medicare doesn’t cover can help you avoid unexpected medical bills and plan ahead for healthcare expenses.
Here are 10 common healthcare services Medicare doesn’t cover.
1. Routine Dental Care
Original Medicare generally does not cover routine dental care.
That means services such as:
- Dental cleanings
- Routine dental exams
- Fillings
- Tooth extractions
- Dentures
- Dental plates
are generally not covered.
There are limited situations where Medicare may pay for certain dental services when they are directly connected to a covered medical procedure. For example, Medicare may cover certain dental services needed before some major medical treatments.
If you need regular dental care, you may want to consider separate dental insurance or a Medicare Advantage plan that includes dental benefits.
2. Eye Exams and Routine Vision Care
Routine eye care is another area where Original Medicare has significant limitations.
Medicare generally doesn’t pay for routine eye examinations for glasses or contact lenses.
It also generally doesn’t cover:
- Eyeglasses
- Contact lenses
- Routine vision testing
However, Medicare can cover certain eye-related medical services. For example, it may cover treatment for cataracts and certain eye diseases.
So, there is an important difference between medical eye care and routine vision care.
3. Hearing Aids
Hearing loss becomes more common with age, but hearing aids can be expensive.
Original Medicare generally does not cover hearing aids or routine hearing exams for the purpose of obtaining or fitting a hearing aid.
This can leave beneficiaries paying the full cost themselves.
Some Medicare Advantage plans, however, offer hearing benefits that may help pay for hearing tests or hearing aids.
4. Long-Term Custodial Care
One of the biggest misconceptions about Medicare is that it covers long-term nursing home care.
Generally, Medicare does not pay for long-term custodial care when a person needs help with everyday activities such as:
- Bathing
- Dressing
- Eating
- Using the bathroom
- Getting in and out of bed
Medicare can cover certain skilled nursing facility services when specific requirements are met, but this is different from long-term custodial care.
If someone needs extended nursing-home care primarily because they cannot independently perform daily activities, other sources of coverage may need to be considered.
5. Routine Physical Exams
Medicare covers certain preventive services, including the Welcome to Medicare preventive visit and an annual wellness visit.
However, these are different from a traditional comprehensive physical examination.
Medicare generally does not cover a routine physical exam simply because a beneficiary wants a complete checkup outside the covered preventive services.
Understanding the difference between a preventive visit and a routine physical examination can help prevent surprise bills.
6. Cosmetic Surgery
Medicare generally doesn’t cover cosmetic procedures performed solely to improve appearance.
Examples can include procedures that are performed only for cosmetic reasons, such as:
- Cosmetic facelifts
- Certain elective body-contouring procedures
- Cosmetic breast procedures
However, Medicare may cover plastic or reconstructive surgery when it is medically necessary.
For example, reconstructive surgery following an accident or surgery to repair a functional problem may qualify for coverage.
The key question is usually whether the procedure is medically necessary, rather than simply cosmetic.
7. Acupuncture for Most Conditions
Medicare coverage for acupuncture is limited.
Medicare Part B covers acupuncture for chronic low back pain when specific coverage requirements are met, including limits on the number of covered sessions.
However, Medicare does not provide broad acupuncture coverage for every condition.
If you are considering acupuncture for another health problem, check your specific Medicare coverage before scheduling treatment because you may have to pay the entire cost yourself.
8. Routine Foot Care
Basic foot care is generally not covered by Original Medicare.
Examples include routine services such as:
- Cutting or trimming toenails
- Removing corns or calluses
- General foot maintenance
There are exceptions when foot care is medically necessary because of certain conditions.
For example, people with diabetes or certain circulation problems may qualify for coverage of specific podiatry services when Medicare’s requirements are met.
9. Medical Services Outside the United States
Original Medicare generally does not cover healthcare received outside the United States, although there are limited exceptions.
This can become particularly important for people who travel internationally.
For example, if you become sick while traveling abroad, you should not automatically assume that Medicare will pay the foreign medical bill.
Some Medicare Supplement plans and Medicare Advantage plans may provide limited coverage for emergency care outside the U.S., depending on the plan.
Always check your plan’s international coverage before traveling.
10. Most Prescription Drugs Under Original Medicare Part B
Another common misunderstanding is assuming that Original Medicare covers all prescription medications.
Generally, Medicare Part B does not cover most prescription drugs that you pick up at a pharmacy.
Many of these medications are instead covered through Medicare Part D prescription drug coverage.
Part B does cover certain medications in specific circumstances, such as drugs administered by a healthcare professional in a medical setting.
So, if you regularly take prescription medications, it’s important to understand whether your medication falls under Part B or Part D.
Why Knowing What Medicare Doesn’t Cover Matters
Healthcare expenses can add up quickly, particularly when a service isn’t covered by Medicare.
Knowing the limitations of your coverage can help you:
- Estimate your healthcare expenses
- Avoid unexpected medical bills
- Compare Medicare Advantage plans
- Consider Medicare Supplement coverage
- Plan for dental, vision and hearing expenses
- Prepare for potential long-term care costs
It’s also important to remember that Medicare coverage can depend on medical necessity, eligibility, location, provider participation and the type of Medicare plan you have.
A service that isn’t covered by Original Medicare may be covered by a Medicare Advantage plan, but benefits and costs vary from plan to plan.
Original Medicare vs. Medicare Advantage
The answer to “Does Medicare cover this?” isn’t always straightforward.
Original Medicare consists primarily of Part A and Part B. Beneficiaries can also purchase Part D prescription drug coverage and, in many cases, a Medicare Supplement (Medigap) policy.
Medicare Advantage (Part C) is offered by private Medicare-approved insurance companies. These plans must cover Medicare-covered services but may offer additional benefits, such as dental, vision or hearing coverage.
Because benefits vary, it’s important to review the details of your specific plan rather than relying only on general Medicare information.
Frequently Asked Questions
Does Medicare cover dental care?
Original Medicare generally doesn’t cover routine dental care, including cleanings, fillings and dentures. Certain medically necessary dental services may be covered in limited circumstances.
Does Medicare pay for glasses?
Original Medicare generally doesn’t cover routine eyeglasses or contact lenses. There are limited exceptions, including certain coverage related to cataract surgery.
Does Medicare cover hearing aids?
Original Medicare generally doesn’t cover hearing aids or routine hearing exams for hearing aids. Some Medicare Advantage plans may offer hearing benefits.
Does Medicare cover nursing home care?
Medicare can cover certain short-term skilled nursing facility care when eligibility requirements are met. It generally does not cover long-term custodial nursing-home care.
Does Medicare cover cosmetic surgery?
Generally, no, when the procedure is performed only to improve appearance. Medically necessary reconstructive procedures may qualify for coverage.
Does Medicare cover care overseas?
Original Medicare generally doesn’t cover healthcare outside the United States, although limited exceptions exist. Some Medicare Advantage and Medigap plans may offer emergency coverage abroad.
Final Thoughts
Medicare provides valuable healthcare coverage, but it isn’t designed to cover every healthcare expense. Dental care, routine vision care, hearing aids, long-term custodial care, cosmetic procedures and several other services may not be covered by Original Medicare.
Before receiving a service, check your specific Medicare plan and confirm whether the service is covered. Understanding your benefits ahead of time can help you make better healthcare and financial decisions.