What doesn’t Medicare cover?

Medicare is a federal health insurance program in the United States that provides coverage for certain medical services and supplies. While Medicare offers broad coverage, there are several items and services that are not covered by the program.

Here are some examples:

  1. Long-term care: Medicare does not generally cover long-term care services such as custodial care in nursing homes, assisted living facilities, or in-home care.
  2. Dental care: Routine dental care, including check-ups, cleanings, fillings, dentures, and most dental procedures, is not covered by Medicare. However, there are certain circumstances where Medicare may cover dental services, such as when they are required in preparation for a Medicare-covered procedure (e.g., jaw reconstruction before radiation treatment for oral cancer).
  3. Vision care: Medicare does not cover routine eye exams, eyeglasses, contact lenses, or most vision correction procedures, with a few exceptions for specific eye conditions or surgeries.
  4. Hearing aids: Medicare does not cover hearing aids or routine hearing exams. However, some Medicare Advantage plans (Part C) may offer hearing aid coverage.
  5. Cosmetic procedures: Medicare does not cover cosmetic surgeries or procedures performed solely for cosmetic purposes.
  6. Acupuncture: Although acupuncture has gained popularity for certain conditions, Medicare generally does not cover acupuncture treatments.
  7. Prescription drugs: While Medicare Part D provides prescription drug coverage, not all medications are covered. Each Part D plan has its own list of covered drugs, known as a formulary, and some medications may require prior authorization or have other restrictions.

It’s important to note that while these items are generally not covered by Original Medicare (Part A and Part B), individuals have the option to enroll in Medicare Advantage plans (Part C) or add supplemental insurance (Medigap plans) that may offer additional coverage for some of these services. It’s recommended to review specific Medicare guidelines and consult with Medicare or an insurance professional to get accurate and up-to-date information regarding coverage.


Schedule Free Consultation