Things About Medicare You Should Never Assume Are Included (Because They Probably Aren’t)

Key Takeaways

• Medicare doesn’t cover everything you might expect, so it’s essential to know what is and isn’t included in your plan.

• Some services, like dental care, hearing aids, and long-term custodial care, require separate coverage or out-of-pocket payments.

The Reality of Medicare Coverage Gaps

Many people assume Medicare covers all their healthcare needs, but that’s far from the truth. While Medicare provides essential medical coverage, it leaves out some services that might surprise you. If you don’t plan ahead, you could be left facing significant out-of-pocket costs. Here’s what you should know about common healthcare services that Medicare doesn’t typically cover.

Routine Dental Care Is Not Included

If you need a routine dental exam, cleaning, or even a filling, don’t expect Medicare to foot the bill. Original Medicare does not cover:

• Routine exams and cleanings

• Fillings, crowns, and root canals

• Dentures and dental implants

• Orthodontic treatments, such as braces or retainers

• Periodontal treatments for gum disease

Medicare may only pay for dental procedures if they are part of a covered medical treatment, such as reconstructive surgery after an accident. Otherwise, you’ll need separate dental insurance or pay out-of-pocket. Even if you have additional coverage, limitations and waiting periods might still apply.

Hearing Aids and Exams Are Your Responsibility

Hearing loss is a common issue as people age, yet Medicare does not cover hearing aids or the exams needed to get them. If you need:

• Hearing tests for a hearing aid prescription

• The hearing aids themselves

• Follow-up fittings or maintenance

• Repairs or replacements for damaged hearing aids

You will need to find alternative coverage or budget for these costs yourself. Some private insurance options might offer hearing benefits, but Medicare won’t pay for these expenses directly. This can be a significant burden since hearing aids can be expensive, and many people require new devices every few years.

Vision Care Is Limited

Medicare covers eye exams in certain situations, like screenings for diabetic retinopathy or glaucoma, but it does not cover routine vision care. Services that Medicare does not include:

• Annual eye exams for glasses or contact lenses

• Prescription eyewear (glasses or contacts)

• LASIK or other corrective vision procedures

• Treatment for conditions like dry eye syndrome or macular degeneration (unless deemed medically necessary)

The only time Medicare may cover vision-related expenses is if they are part of a medical treatment, such as cataract surgery. Otherwise, you’ll need to explore other options for vision coverage.

Long-Term Care Is a Huge Gap

One of the biggest misconceptions about Medicare is that it pays for long-term care. However, Medicare does not cover custodial care in a nursing home or assisted living facility. This means:

• If you need help with daily activities like bathing, dressing, or eating, Medicare will not cover it.

• Nursing home stays are only covered for a short period after a hospital stay, not for ongoing care.

• You’ll need to pay out of pocket or look into long-term care insurance for extended stays.

• Assisted living facilities that provide room, board, and personal care are not included in Medicare benefits.

Planning for long-term care is crucial, as costs can add up quickly, and many seniors find themselves unprepared for these expenses.

Prescription Drug Coverage Requires a Separate Plan

If you only have Original Medicare, don’t assume your prescriptions will be covered. Medicare Part A and Part B do not include most outpatient prescription drugs. To get drug coverage, you need to enroll in a separate Medicare Part D plan or another form of prescription drug coverage. Even then:

• You may have to meet a deductible before coverage kicks in.

• Some medications may not be covered, depending on the plan’s formulary.

• Costs can vary depending on the specific prescriptions you take.

• Specialty drugs, such as those for chronic conditions, may have higher co-pays.

Foreign Medical Care Is Rarely Covered

Planning a trip outside the U.S.? Be aware that Medicare does not usually cover healthcare services you receive in a foreign country. If you have a medical emergency while traveling internationally, Medicare won’t pay for:

• Emergency hospital stays

• Doctor visits

• Medical evacuations back to the U.S.

• Prescriptions purchased abroad

There are some exceptions, like if you’re in Canada and traveling directly between Alaska and another U.S. state, but generally, you’ll need separate travel insurance to cover medical expenses abroad. Some Medigap policies may offer limited foreign travel emergency benefits, but it’s essential to check your plan before traveling.

Routine Foot Care Isn’t Covered

Medicare does not cover most routine foot care unless it is medically necessary due to a condition like diabetes. If you need:

• Corn and callus removal

• Routine nail trimming

• General foot exams

• Custom orthotics for comfort

You’ll likely have to pay for these services yourself. Only foot care related to serious medical conditions will qualify for coverage.

Alternative and Acupuncture Therapies Are Limited

Many people turn to alternative therapies for pain management or chronic conditions, but Medicare has strict limits on what it will cover. While Medicare covers acupuncture for certain conditions, like chronic lower back pain, it does not cover:

• Chiropractic adjustments beyond spinal subluxation treatments

• Massage therapy

• Herbal medicine or naturopathy

• Homeopathic treatments

If you rely on alternative treatments, be prepared to pay out-of-pocket. Some private plans might offer limited coverage, but Original Medicare does not.

Cosmetic Procedures Are Not Covered

Any medical procedure that is considered cosmetic is not covered by Medicare. This includes:

• Elective plastic surgery

• Botox for wrinkles (unless used for a medical condition like migraines)

• Teeth whitening and other cosmetic dental procedures

• Fat removal or skin tightening procedures

Only procedures deemed medically necessary may be considered for coverage.

Personal Care and Home Health Aides Come With Restrictions

If you need assistance at home with daily living tasks, Medicare does not cover long-term personal care. Medicare will only cover home health care under specific conditions, such as after a hospital stay and when prescribed by a doctor. However:

• You must be homebound for Medicare to cover intermittent skilled nursing care.

• 24-hour home health aides are not covered.

• Non-medical home assistance, such as housekeeping or meal preparation, is not included.

• Family caregivers are not compensated through Medicare.

How to Avoid Costly Surprises

Understanding what Medicare does and does not cover can save you from unexpected expenses. Here’s what you can do:

• Review your Medicare plan carefully – Make sure you understand its limitations.

• Consider additional insurance – Look into supplemental coverage for dental, vision, and hearing needs.

• Budget for out-of-pocket costs – Plan ahead for expenses that Medicare won’t cover.

• Talk to a licensed agent – A professional can help you explore coverage options that fit your healthcare needs.

Make Sure You Have the Coverage You Need

Medicare is an essential healthcare program, but it doesn’t cover everything. Many important services, from dental care to long-term care, require additional coverage or personal savings. To avoid unexpected costs, review your options and consider supplementing your Medicare plan where necessary. If you’re unsure about your coverage or need expert guidance, reach out to a licensed agent listed on this website for professional advice.