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Top 7 Services Original Medicare Does Not Cover

Summary: As a current or soon-to-be Medicare beneficiary, you may wonder, what does Medicare not cover? Here, we will discuss seven important medical services Original Medicare doesn’t cover and some potential ways you can get coverage for any missing services. Estimated Read Time: 7 mins

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Table of Contents:

    1. What is Not Covered by Medicare?
    2. Foreign Travel Health Coverage
    3. Prescription Drug Coverage
    4. Routine Vision Coverage
    5. Routine Dental Coverage
    6. Hearing Aids Coverage
    7. Routine Foot Care Coverage
    8. Long-Term Care Coverage

What is Not Covered by Medicare?

Original Medicare (Medicare Part A and Medicare Part B) unfortunately doesn’t cover all the medical services you may need.

Medicare Part A mainly covers inpatient hospital care. This includes emergency room care, hospital stays, skilled nursing facility care, hospice care, and some home health care.

Medicare Part B is outpatient medical insurance. It covers a wide range of medically necessary outpatient services such as primary care physician visits, preventive services (such as vaccinations and screenings), lab tests (such as bloodwork), outpatient surgery, durable medical equipment (such as canes and wheelchairs), and some ambulance transport.

But Original Medicare doesn’t cover many other important services because it’s a federal program and it’s very likely running low on available funds to cover everything. Many of the services Original Medicare doesn’t cover are often covered through additional plans with private insurance companies.

Original Medicare does not cover:

  • Overseas healthcare
  • Most prescription drugs
  • Vision care
  • Dental care
  • Hearing aids
  • Routine foot care
  • Long-term care

However, there may be other forms of health insurance that can cover these services that you can enroll in.

List of health services that Original Medicare does not cover

#1 Foreign Travel Health Coverage

First on our list of services Medicare does not cover is foreign travel health care coverage. When reaching retirement age, it is not uncommon to dream of traveling the world. However, when traveling, it is essential to be sure you have health coverage to cover your needs in case of an emergency abroad.

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Unfortunately, Original Medicare does not cover any health care services when traveling outside of the U.S. However, there may be options for you through alternate coverage options if you wish to receive coverage abroad.

To fill this hole in Original Medicare coverage, certain Medicare Supplement (Medigap) plans offer foreign travel emergency coverage. This helps cover medical costs in case of an emergency while abroad. These plans offer 80% coverage up to $50,000 for foreign travel benefits after you meet the foreign travel deductible.

Enrolling in a plan that offers foreign emergency healthcare can help save you hundreds or even thousands of dollars if an emergency were to strike while you are traveling. Thus, if your retirement plans include going abroad, a Medigap plan may be the right option for you.

#2 Prescription Drug Coverage

Unlike most employer coverage plans you may be used to, another vital service not covered by Original Medicare is prescription drug coverage.

Original Medicare is made up of two parts. Medicare Part A is hospital insurance, and Medicare Part B is medical insurance, including outpatient care and medical supplies. However, neither part includes coverage for prescription medications.

To receive help covering the cost of prescription drugs, you have the option to enroll in Medicare Part D prescription drug coverage. You can enroll in Medicare Part D when you first become eligible for Original Medicare. Plus, you have the option to change plans each year during the Annual Enrollment Period.

It’s important to enroll in a Medicare Part D plan even if you are not currently taking any prescription medications.  If you delay prescription drug coverage, you could be subject to paying a late enrollment penalty if you do not have creditable coverage.

Plus, enrolling in Part D coverage can be useful if you are prescribed drugs throughout the year. This coverage will help keep costs low and reduce your out-of-pocket responsibility.

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#3 Routine Vision Coverage

Another benefit not covered by Medicare is vision coverage. Routine vision care is a necessity many Medicare beneficiaries go without. As we age, our eyesight is known to deteriorate. Thus, finding alternate forms of coverage is essential for Medicare beneficiaries.

Only around 19% of all Medicare beneficiaries had vision coverage in 2020. This means almost 80% of Medicare beneficiaries paid 100% of their vision costs out-of-pocket.

Original Medicare doesn’t cover routine eye exams, eyeglasses, contacts, or LASIK laser eye surgery. However, you can enroll in a standalone vision plan to help cover some of these costs.

#4 Routine Dental Coverage

Number four on the list of services Original Medicare does not cover is routine dental care. If you need coverage for annual dental exams or cleanings, Original Medicare alone will not be of service to you. For aging Baby Boomers, dental care is an important element for preventing many major health concerns. However, many seniors on Medicare do not have additional dental coverage.

Because Medicare does not cover dental services, beneficiaries are often left covering these expenses out-of-pocket. Nearly 37 million people on Medicare do not have dental coverage. That is just over half of all seniors.

If you enroll in a Medicare Supplement plan, a stand-alone dental plan could benefit you. These plans offer dental coverage for care ranging from preventive exams to major services like oral surgery or dental implants.

#5 Hearing Aids Coverage

Despite many seniors having at least partial hearing loss, hearing aids are not covered under Original Medicare. Congress introduced the Medicare Hearing Aid Coverage Act in 2021 and again in 2023 to get hearing aids covered under Medicare. Unfortunately, it still hasn’t passed.

Medicare Part B will only cover a hearing exam as a test to see if you have a related condition. For example, if you have fallen down multiple times within a short timeframe, a doctor may issue a diagnostic hearing and balance exam. However, Medicare won’t cover a test to see if you need a hearing aid or a fitting for a hearing aid.

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A standalone hearing plan could help you with the cost of prescription hearing aids.

There is also the option of over-the-counter hearing aids. OTC hearing aids were just approved by the FDA in August 2022 and are becoming available in more and more stores such as CVS.

It’s important to note that OTC hearing aids only work if you have mild to moderate hearing loss. They’re also still pretty expensive at around $250-$3000 per pair, and no health insurance plan will cover OTC hearing aids.

#6 Routine Foot Care Coverage

Medicare Part B will cover podiatry if it’s related to a medical condition, such as diabetes. Part B will also cover the treatment of most foot injuries and diseases.

However, Part B will not cover routine foot care. If you need removal or cutting of corns or calluses, a nail trim, or other hygienic foot maintenance such as cleaning or soaking, then you would be responsible for 100% of the bill. Part B also typically will not cover the treatment of flat feet or orthopedic shoes.

#7 Long-Term Care Coverage

Completing the list of services Original Medicare does not cover is long-term care. Long-term care can potentially become one of your largest, unexpected expenses after retirement that Original Medicare does not cover. Original Medicare will only cover a set number of days in a skilled nursing facility. However, it does not cover custodial care such as dressing, bathing, toileting, and other necessary activities of daily living.

Approximately 7 of 10 people over the age of 65 will eventually require care in a long-term care facility. In 2021, the average cost of long-term care was nearly $10,000 for a private room.

A long-term care insurance policy through a private company may be able to help you pay for expenses related to long-term care.

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We have helped over 250,000 Medicare clients find their Medicare coverage

How to Find Additional Coverage for Medicare

If you are looking for additional coverage for benefits not covered by Original Medicare, our licensed insurance agents are here to help! We review all plans in your area to ensure you have the best coverage possible.

We understand the importance of healthcare coverage, so we want to be sure you are enrolled in the best Medicare plan that fits your needs. Call the number above or complete our online rate form to get started today.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Why Doesn’t Medicare Cover Services So Many Seniors Need?. Accessed September 2023.
    https://kffhealthnews.org/news/article/healthbent-medicare-benefits-expansion-dental-vision-hearing-services-seniors-need/
  2. Cost of Care Survey. Accessed September 2023.
    https://www.genworth.com/aging-and-you/finances/cost-of-care.html
  3. Medicare Coverage Outside United States, Medicare. Accessed September 2023.
    https://www.medicare.gov/Pubs/pdf/11037-Medicare-Coverage-Outside-United-States.pdf
  4. Medicaid and Medicare Enrollees Need Dental, Vision, and Hearing Benefits. Accessed September 2023.
    https://www.cbpp.org/research/health/medicaid-and-medicare-enrollees-need-dental-vision-and-hearing-benefits
  5. Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries. Accessed September 2023.
    https://www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries/
  6. CMS Items and Services Not Covered Under Original Medicare. Accessed September 2023.
    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Items-Services-Not-Covered-Under-Medicare-Text-Only.pdf
David Haass

David Haass

David Haass is the Chief Technology Officer and Co-Founder of Elite Insurance Partners and MedicareFAQ.com. He is a member and regular contributor to Forbes Finance Council and stay up-to-date with the latest Medicare trends and changes. He holds a Bachelor of Science in Business Administration and Management from the University of Florida.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

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