Medicare was designed to provide healthcare coverage for seniors 65 and over and to help lower out-of-pocket costs so costly medical expenses could be avoided. While Medicare does provide a good deal of coverage for inpatient and outpatient services, it doesn’t cover everything.

For example, Original Medicare does not provide coverage for services such as acupuncture, chiropractic services, and cosmetic procedures that are not deemed medically necessary. Original Medicare also does not provide coverage for routine dental care. This includes dentures, oral cleanings, extractions, fillings, root canals, etc. You also won’t receive coverage for hearing or vision services. Medicare does not provide coverage for hearing exams, hearing aids, routine vision care, eye glasses, contacts, etc. However, Medicare Part B covers preventive or diagnostic eye exams such as glaucoma screenings for high-risk enrollees. 

Medicare Advantage may provide coverage for dental, hearing, and vision services, but this will depend on the plan.

Other services not covered by Medicare include:

Prescription Drug Coverage

Prescription drugs are not covered under Original Medicare unless they are provided to you while you are admitted as an inpatient or receiving treatment as an outpatient. As far as daily prescriptions you can take at home, you will need to enroll separately under Medicare Part D because Original Medicare will not provide coverage for that. Some Medicare Advantage plans also include coverage for prescription drugs as part of their services, but of course, this will depend on the plans available in your area and what they cover. 

Care Received Outside the United States

Generally, Medicare does not cover health services you receive while traveling outside of the United States, the District of Columbia, Puerto Rico, American Samoa, Guam, the United States Virgin Islands, and the Northern Mariana Islands. However, there is an exception if you need emergency care and a foreign hospital is closer than the nearest U.S hospital. 

Some Medicare Supplements will provide coverage for out-of-country care, but if you are not enrolled in a supplement plan that does cover this, you will be responsible for the costs.

Long-term Care

Medicare does not provide coverage for long-term care services. However, Medicare can cover short stays at a nursing home or skilled nursing facility care when it follows an inpatient hospital stay.  Medicare also does not cover nursing home stays when personal care is the only service you need.

If long-term care is necessary for you to have, your best option would be to enroll in a separate long-term care insurance policy while staying enrolled in Medicare.

If you are enrolled in Medicare or are eligible to enroll and still need help understanding what exactly will be covered by Medicare, reach out to Game Changing Benefits today. Our goal is to make sure you have the coverage you need, so give us a call and we can make sure you get just that.