10 Things Original Medicare Does Not Cover

One of the most common misconceptions about Medicare is that it covers all the services you might have received under your previous private health insurance. Although Medicare Part A and Part B, also known as Original Medicare, covers a wide range of healthcare services and devices, it excludes a number of things some seniors might need.

Understanding what is not covered by Original Medicare is extremely important when you’re making a decision about which Medicare plan is right for you. Should you have a need for some of these excluded items or services, you would need to pay for them out of pocket, which might add up to extraordinary costs over time.

Let’s take a closer look at the gaps in Original Medicare coverage and whether it’s possible to fill them.

What is covered by Original Medicare?

Before discussing some of the major services that are not covered by Original Medicare, it’s a good idea to develop an understanding of all the things Parts A and B do cover.

Medicare Part A is your hospital insurance. This segment of Medicare covers inpatient care in a hospital, short-term skilled nursing facility care, short-term nursing home care, hospice care and home health care.

Medicare Part B includes medical and outpatient care services. These include things like doctor’s office visits, diagnostic testing, durable medical equipment prescribed to you by a doctor, and inpatient and outpatient mental health services. Medicare Part B also covers some preventative healthcare services, such as bone density and cardiovascular screenings, some vaccinations, and a yearly wellness visit.

What is not covered by Original Medicare?

Although Original Medicare covers a wide variety of services and equipment the average senior might need to protect their health, it still leaves out a lot of services most people come to expect as part of their wellness coverage.

While not exhaustive, here are a number of things Original Medicare does not cover.

Prescription drugs: One of the most important things to understand about Original Medicare is that Parts A and B do not include coverage for most prescription drugs. Medicare Part B covers some outpatient prescription drugs, but the large majority of medications you might be prescribed will not be covered. In order to have your prescription drugs covered by insurance, you’ll need to purchase Medicare Part D — a Medicare Prescription Drug plan.

Custodial nursing home care: Medicare Part A covers inpatient stays in a hospital or a skilled nursing facility if you require care while healing from an injury or other ailment. However, it does not cover long-term stays at a nursing home when the patient only needs custodial care — help with daily activities like bathing, dressing, eating and moving around. Nursing home costs can add up quickly, and bills like these can come as quite a surprise to seniors who do not realize that nursing home care is not covered by their Medicare plan.

Dental care: Dental care is often considered a crucial aspect of healthcare. Unfortunately, most dental care services are excluded from Original Medicare coverage. If you need routine dental services like cleanings, fillings or extractions, or major dental services like dentures, these will not be covered if you only have Medicare Part A and Part B.

Vision services: It’s common for seniors to encounter vision troubles as they age. However, routine vision care, including vision exams and eyeglasses, are not covered under Original Medicare. If you’re someone who requires a yearly exam to maintain proper vision, the costs without coverage could really add up!

Hearing aids: Yet another common senior health problem is impaired hearing. Unfortunately, yearly hearing exams and hearing aids — which could cost thousands of dollars per year — are not covered by Medicare Parts A and B.

Podiatry: Although some medical-related podiatry services are covered by Medicare Part B, such as injuries or diabetes-related nerve damage, other foot care services are not covered by Medicare. These might include callous removal and orthopedic shoes or supportive devices.

Cosmetic surgery: Elective cosmetic surgery is not included in Original Medicare coverage. This means that cosmetic procedures like face lifts will need to be paid for 100% out of pocket. Medicare may pay for some medically necessary plastic surgery in the event of an injury or other serious ailment.

Alternative care: Services that are generally considered part of the “alternative medicine” umbrella, including chiropractic care, massage therapy and acupuncture, are also not covered by Original Medicare.

Home safety items: Certain home safety improvements, such as grab bars, raised toilet seats, stair lifts and nonslip flooring often make it safer and easier for mobility-impaired seniors to navigate their homes. However, many of these items are not considered “medically necessary” and are typically excluded from Original Medicare coverage. Some home safety items may be covered if they are prescribed by your doctor and are deemed to be durable medical equipment, but not all will be.

Healthcare overseas: If you plan on using your retirement years to travel the world, be mindful that Original Medicare may not cover any healthcare services you need while you’re out of the country. Depending on where you travel and what forms of healthcare you need, you could end up with a large bill without any insurance coverage.

There are many particulars to exactly what is and what is not covered by Original Medicare. To learn more about whether a particular device or service is covered under Medicare Part A or Part B, you can search for it on Medicare.gov.

How to add coverage for excluded items and services under Medicare

If you’re like many of the millions of people on Medicare, you might identify one or more of the healthcare services on the list above that you believe you’ll need to stay healthy and safe. If you maintain only Original Medicare, you could end up paying thousands of dollars out of pocket for these services each year.

Fortunately, there are a few ways to have some of these things covered. There are options that may include one or more of the services and devices Original Medicare excludes.

Prescription Drug plans: Medicare Part D, or Medicare Prescription Drug plans, are separate insurance policies that provide coverage for prescription medications. These plans can be purchased alongside Original Medicare, or they might be rolled into a Medicare Advantage plan. If you believe you’ll need to take prescription medications, enrolling in Medicare Part D may help you save money.

Medicare Advantage plans: Medicare Part C, or Medicare Advantage plans, are “all-in-one” insurance plans sold by private companies. These plans include coverage for Medicare Parts A and B, but they might also include additional coverage, including prescription drugs, and other health and wellness benefits. This type of plan might be useful if you require one or more routine service Original Medicare does not cover.

Medigap plans: Medigap plans, also known as Medicare Supplement plans, typically help cover the out-of-pocket costs remaining after Medicare Parts A and B pay for services. However, some Medigap plans offer coverage for emergency healthcare you receive outside the U.S. This type of plan might be useful if you expect to travel frequently during retirement.

With only Original Medicare, you might encounter gaps in your coverage that you did not expect. If you’re interested in exploring your Medicare options beyond Original Medicare, PlanEnroll represents a range of plans that can expand your coverage. Reach out today so we can help!

https://www.medicare.gov/publications/11037-medicare-coverage-outside-the-united-states.pdf

https://www.medicare.gov/providers-services/original-medicare

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