Medicare doesn’t cover everything. But, many seniors believe they pay a monthly premium and have full coverage.
As beneficial as full coverage sounds, we’re not there yet. Almost all insurance has a deductible, coinsurance, or co-payment.
But what about services Medicare doesn’t cover? Do you have to pay those bills out of your pocket?
The truth? Yes, you’ll pay the ENTIRE bill for services Medicare doesn’t cover. Don’t worry; we put together some solutions to get you closer to the care you want.
Learn everything about the services Medicare won’t cover, below!
13 Healthcare Services Medicare Doesn’t Cover
Medicare covers many services, but it doesn’t cover everything. There are limits to coverage. Knowing ahead of time can save you money in the long run.
Many seniors have a fixed-income and can’t afford to be without insurance. Medicare has specific guidelines, but there are alternatives to coverage.
If you want treatment, but aren’t sure about the coverage, we have all the details.
Alternative medicine includes a variety of therapies. Examples are homeopathy, acupuncture, and medical marijuana.
Medicare doesn’t cover alternative medicine. But, Medicare may include services that could fall into this category.
Chiropractic care is an alternative medicine, but this care could be essential for patients in need of spine manipulation.
If a doctor can provide a referral for the treatment and show it’s a necessity, Part B may cover some of the costs.
Medicare covers procedures that doctors prescribe. These treatments must be available through outpatient clinical settings or hospital care.
Tip: Call alternative medicine doctors in your area to find the best cash rates.
Medicare doesn’t cover cosmetic surgeries. But, there might be exceptions to this rule.
Sometimes cosmetic surgeries help improve the functionality of a body part. Also, it can cover breast protheses if you’ve had to have a mastectomy from breast cancer.
If Medicare approves your claim, the Medigap company must as well. Those with Medigap pay less out of pocket for services that have approval.
Tip: Cosmetic surgery won’t have coverage, and you’ll pay 100% of the costs of the operation.
Medicare doesn’t cover dental procedures unless it relates to a medical condition. Such as a broken jaw from an accident.
Dental procedures like cavity fillings or cleanings won’t have coverage. Still, if you need a dental procedure because of a medical condition, insurance might cover it.
Many hospital inpatient procedures fall under Medicare coverage terms. But, a trip to the E.R. for an abscessed tooth may not fall under those same terms.
Tip: Get stand-alone dental coverage. The routine care plans don’t cover enough, call one of our agents today!
Do you need a routine eye exam? If the answer is yes, you can guarantee there’s no coverage. But, Medicare does cover a pair of corrective lenses after cataract surgery.
Even then, your glasses have to come from a supplier who works with Medicare to get full coverage on them. Otherwise, you’ll pay out of pocket.
Tip: There are stand-alone vision plans with comprehensive benefits; our agents can help you.
While Medicare doesn’t cover hearing aids and exams. You need a stand-alone hearing plan.
You’ll pay 100% of the costs for exams and hearing aids. Often, plans include hearing aids, which are quite costly.
The Medicare Act of 1965 enacted the exclusion of hearing aid benefits. Back then, seniors weren’t living as long, so fewer people had hearing loss as they got older.
Advantage plans may offer a variety of hearing benefits, though the coverage isn’t comprehensive.
TIP: Talk to our agents about the coverage you want, they can help find your policy match!
Traveling outside of the United States may land you in a spot of non-coverage when it comes to your benefits.
Medicare covers foreign travel in infrequent circumstances. Some Medigap plans include foreign travel emergency benefits.
Circumstances when Medicare covers foreign travel:
- If you take a cruise and are less than 6 hours from a port
- Getting sick in the United States but the closest hospital is in another country
Tip: Many Supplement and Advantage plans cover health care costs when traveling abroad.
Home Health Care and Long Term Care
Medicare doesn’t cover long-term care if that’s the only form of care you need. Any custodial care like dressing and bathing won’t fall under Medicare’s terms.
The majority of those in need of long-term care have a disability or chronic condition. If you’re an inpatient for three or more days in a row, Medicare covers your stay at a skilled nursing facility.
In a situation such as this, Medicare covers therapies, nursing care, your room, and meals while in the nursing facility.
Long-term care tends to be the most popular form of care. There are different routes available if you need care, such as long term care insurance.
Tip: If you have a whole life insurance policy, funds from that account can be used for long term care!
Medicare won’t cover housekeeping, shopping, personal care, meal delivery, and other similar services. Some Advantage plans include services like this.
It depends on which plans are available in your service area; not all policies offer the same benefits. Medigap won’t cover personal services.
Tip: Coupon sites like “Groupon” sometimes offer discounts on personal services.
Skilled Nursing Care
Medicare has some limitations when it comes to Skilled Nursing care. Medicare pays for your first 20 days of skilled nursing care at 100%.
In the following 80 days, Medicare pays 80%. There is no coverage for any skilled nursing care beyond 100 days.
Some Advantage plans do provide benefits beyond the 100 days. Consider looking into all your options.
Tip: Our agents can help you identify a policy today!
Medicare won’t usually cover transportation for routine health care. But, some non-emergency ambulance transportation may be available.
The trip would need a written order from the doctor ahead of time, stating the need for transport. Further, some Advantage plans include transportation for doctor visits.
Medicare won’t cover ambulette services. Also, Medicare doesn’t cover an ambulance due to a lack of alternate transportation.
If you’re in a skilled nursing facility, the ambulance has coverage through the SNF. So, the SNF shouldn’t bill Medicare for the ride.
Tip: Rideshares like Lyft and Uber sometimes have discount codes for new users; if your plan can’t get you a ride, your phone can!
You may see a podiatrist when you have bunion deformities, heel spurs, or hammertoes. Those things all have coverage.
Further, those with diabetes, you can get a foot exam every six months. But, when it comes to routine foot care, you’re on your own.
Tip: Coupon sites like “Groupon” sometimes run deals on manicures or pedicures!
Routine Physical Exams
Services may include women’s well care services, lung cancer screenings, or prostate screenings. Medicare covers Annual Wellness Visits; these visits are different than a routine physical.
Physical exams check vital signs, lung exams, and may conduct lab tests. While Medicare won’t cover a routine physical, some preventive services have coverage.
Most importantly, talk to your doctor before you assume you do or don’t have coverage.
Tip: Ask about cash prices, sometimes doctor’s offices negotiate costs; they’re a business after all.
Medical Record Copies
Medicare covers health care services and medical supplies that are necessary. It’s always best to have a plan of action ahead of time.
Should you need services Medicare won’t cover; you’ll wish you had extra protection. Advantage and Supplement plans offer more value than Medicare.
Supplementary coverage can save you money. Who doesn’t love to save money?
Let our team of experts assist you in finding the perfect plan for you! Give us a call at the number above to see how much you can save!
Can’t call right now? No problem, fill out the online rate comparison form to get closer to your best policy!