10 Essential Services Not Covered by Original Medicare
10 Things Original Medicare Does Not Cover.Understanding what Original Medicare doesn’t cover is crucial for planning your healthcare expenses. Let’s explore ten key areas where you might need additional coverage or alternative solutions.
1. Prescription Drugs: A Critical Gap in Coverage
Most self-administered prescription drugs fall outside Original Medicare’s scope. However, you’re not left without options.
When Medicare Does Cover Drugs
- Inpatient hospital stays (Part A)
- Provider-administered drugs in medical facilities (Part B)
Your Options for Drug Coverage
- Standalone Medicare Part D policy
- Medicare Advantage (Part C) plan
- Prescription drug discount cards
Warning: Avoid Coverage Gaps
Enroll in drug coverage when first eligible to avoid long-term premium penalties.
2. Routine Vision Care: Seeing the Bigger Picture
While Original Medicare covers some vision-related medical conditions, it leaves routine eye care uncovered.
What’s Covered
- Treatment for conditions like glaucoma, cataracts, and macular degeneration
- Vision issues related to diabetes
- One pair of eyeglasses after cataract surgery
What’s Not Covered
- Routine eye exams
- Prescription glasses
- Contact lenses
Alternative Solutions
Consider a standalone vision insurance policy or a Medicare Advantage plan with vision benefits.
3. Hearing Care: Listen Up for Coverage Gaps
Original Medicare’s hearing coverage is limited, leaving many seniors to cover these costs out-of-pocket.
Medicare Covers
- Diagnostic hearing exams related to other conditions
- Treatment for medical conditions affecting the ears
Medicare Doesn’t Cover
- Routine hearing tests
- Hearing aids
Exploring Your Options
Look into standalone hearing insurance, discount plans, or Medicare Advantage plans with hearing benefits. For mild to moderate hearing loss, consider over-the-counter hearing aids now available without a prescription.
4. Dental Care: Filling the Gaps in Coverage
Original Medicare’s dental coverage is extremely limited, leaving most routine and preventive care uncovered.
What Medicare Covers
Specific emergency or complex dental procedures performed during inpatient hospital stays (Part A)
What’s Not Covered
- Routine dental visits
- Teeth cleanings
- Fillings
- Dentures
- Most tooth extractions
Bridging the Gap
Consider standalone dental insurance, dental discount plans, or Medicare Advantage plans with dental benefits.
5. International Travel Coverage: Protecting Your Health Abroad
When you travel outside the U.S., Original Medicare typically won’t follow you.
Limited Exceptions
- Medical emergencies within six hours of a U.S. port on cruise ships
- Travel between Alaska and another state in Canada
Coverage Options for Travelers
- Medigap plans (up to 80% coverage for emergency care)
- Some Medicare Advantage plans (limited coverage)
- Travel insurance with medical coverage
Planning to Move Abroad?
Consider the implications for your Medicare coverage and potential penalties if you return to the U.S.
6. Routine Foot Care: Steps to Take for Coverage
Original Medicare draws a clear line between medical foot care and routine maintenance.
What’s Covered (Part B)
- Foot injuries
- Ailments like bunions, heel spurs, and hammer toe
- Foot exams and treatment for diabetes-related nerve damage
What’s Not Covered
- Corn removal
- Callus removal
- Preventive or maintenance foot care
Budgeting for Foot Care
Include routine foot care expenses in your healthcare budget, as insurance options are limited.
7. Cosmetic Surgery: Understanding the Limits
Medicare’s approach to cosmetic surgery focuses on medical necessity rather than aesthetic improvements.
Covered Procedures
- Surgeries to correct accidental injuries
- Procedures to improve function from malformations
- Breast reconstruction after mastectomy
- Medically necessary rhinoplasty or eyelid lifts
Non-Covered Procedures
- Facelifts
- Tummy tucks
- Elective breast augmentation
Financing Cosmetic Procedures
Without a clear medical reason, you’ll need to explore alternative financing options for cosmetic surgeries.
8. Chiropractic Services: Aligning Your Coverage Expectations
Medicare’s chiropractic coverage is limited to specific conditions and treatments.
What Medicare Covers (Part B)
One spine manipulation to correct vertebral subluxation
What’s Not Covered
- Most chiropractic services
- X-rays ordered by chiropractors
Seeking Broader Coverage
If chiropractic care is essential for you, consider Medicare Advantage plans that may offer more comprehensive coverage.
9. Alternative Treatments: Exploring Non-Traditional Options
Medicare’s stance on alternative treatments is evolving, but coverage remains limited.
Covered Alternative Treatments
- Acupuncture for chronic low-back pain (up to 20 treatments per year)
- Prescribed physical and occupational therapy
Non-Covered Treatments
- Massage therapy
- Most alternative medicine practices
Seeking Alternatives
Consult your healthcare provider about covered pain management strategies or consider Medicare Advantage plans with broader alternative treatment coverage.
10. Long-Term Care: Preparing for Future Needs
Long-term care represents a significant gap in Medicare coverage that requires careful planning.
What Medicare Covers
- Limited skilled nursing services after qualifying hospital stays
- Up to 100 days of skilled nursing care (with coinsurance)
What’s Not Covered
- Custodial care in nursing homes or assisted living facilities
- Long-term home health aide assistance
Planning for Long-Term Care
Consider long-term care insurance, life insurance with long-term care riders, or explore Medicaid eligibility for comprehensive coverage.
Conclusion: Bridging Your Medicare Coverage Gaps
Understanding what Original Medicare doesn’t cover empowers you to make informed decisions about your healthcare coverage. By exploring supplemental insurance options, Medicare Advantage plans, and alternative solutions, you can create a comprehensive healthcare strategy that meets your unique needs and budget.
