What Medicare Doesn't Cover

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Lots of Americans believe they have arrived on “Easy Street” when they enroll for Social Security and Medicare. In a sense, they have arrived on that fabled avenue. All those payments they have been making to Social Security during their working years are finally paying off and will now come back to them in the form of monthly Social Security payments. Some of the money they have paid in the past will also help fund their Medicare coverage, which will contribute toward medical and health care expenses.

Those first steps on Easy Street, however, can become just a little bit bumpy when people discover that they will still have to pay some unexpected health care and medical bills that are not covered by Medicare.

What Isn’t Covered by Medicare?

What expenses are not covered? Here’s a checklist.

Not Fully Covered: The Full Cost of Your Monthly Medicare Premiums

True, most enrollees will not pay a monthly or annual premium for services that are included in Part A (Original) Medicare, including inpatient hospital services.

However, Medicare enrollees will have to pay a monthly premium for Part B services, which include the majority of services they will receive outside the hospital. In 2022, this monthly fee is $170.10, but if you are earning a sizeable income, you will pay even more. There are still out of pocket costs (Deductibles, Copays, Coinsurance) you will have to meet before Medicare will cover the costs of service.

What can you do to secure coverage? Shop for a Medicare Supplement or Medicare Advantage Plan. CoverRight Medicare advisors are available to help you compare policies and find one you can afford that will cover the services you will need.

Not Covered: Long-Term Care

Medicare generally does not cover long-term care costs, which can be high enough to drain the financial resources of many families.

Long-term care is defined as medical and life-support services for people who have become unable to perform daily tasks such as preparing meals, dressing, or bathing. Bear in mind, that some people require such assistance for long periods of time.

What can you do to secure coverage? You will need to apply and be accepted for a long-term care insurance policy. The earlier you apply for one of these policies, the less it will cost – and the more likely it is that you will be accepted.

Not Covered: Dental Services

Original Medicare will not cover the cost of cleanings, dentures, extractions, fillings, implants, or even routine visits to your dentist.

What can you do to secure coverage? Buy a dental insurance policy – either a stand-alone policy or find a Medicare Advantage Plan that covers the cost of some dental services. Not all plans cover dental procedures. A CoverRight Medicare Concierge can help you find one that does.

Not Covered: Hearing Aids

Original Medicare doesn’t cover the cost of hearing aids.

What can you do to secure coverage? Most Medicare Advantage and Medicare Supplement Plans will pay for a hearing test and may pay a specified amount toward the purchase of hearing aids if you need them. If you need hearing aids or expect that you might in the future, consider buying a plan that includes coverage to help reduce the cost of hearing aids.

Partly Covered: Eye Exams, Glasses, Contact Lenses, and Cataract Removal

Original Medicare does not cover the cost of eye exams, eyeglasses, or contact lenses. However, Original Medicare will cover the cost of eye exams for members who have diabetes. In addition, Original Medicare will pay for the cost of glaucoma screening.

What can you do to secure coverage? Some Medicare Advantage plans will pay toward eyeglasses and contact lenses. And those plans will also cover some of the expense of having cataracts removed. A CoverRight Medicare Concierge can help you find a Medicare Advantage or Medicare Supplement Plan that will cover the expenses of cataract surgery and diabetic eye care.

Acupuncture, Chiropractic, and Alternative Treatments

Even though many patients see these forms of care as mainstream, Original Medicare will not pay for them.

What can you do to secure coverage? Not all Medicare Advantage or Medicare Supplement Plans will provide coverage for these modalities – though some will. If you rely on one of these forms of care, speak with a CoverRight Medicare Concierge, who will work with you to help find the policy you need.

Partly Covered: Gender Reassignment Surgery

You might be surprised to learn that starting in 2014, gender reassignment surgery became covered under Original Medicare Part A – but only in cases of medical or psychological necessity. You will need to provide letters from physicians stating that you need the surgery because you are suffering from a condition called gender dysphoria or that there is a medical necessity that determines you need it.

What can you do to secure coverage? Speak with your primary care physician and other members of your care team to see if they believe you need gender reassignment surgery and whether Medicare will provide coverage.

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