Original Medicare — parts A and B — doesn’t cover it all. With Medicare Part A, beneficiaries are covered for most hospital inpatient services. And Medicare Part B is outpatient medical coverage that takes care of medically necessary services and supplies. But what does Medicare not cover?

Of course, when it comes to Original Medicare, your clients will need to pay their deductible and any applicable coinsurance. These amounts change from year to year, so be sure you have the latest figures when helping your clients plan their health care.

There are some exceptions, but common services Medicare typically doesn’t cover include:

  • Most dental care, including dentures and dental implants
  • Most vision care, including eye exams for glasses and contacts
  • Hearing aids and exams for fitting them
  • Long-term or custodial care
  • Most cosmetic surgery
  • Massage therapy and acupuncture
  • Routine foot care
  • Personal comfort items and services
  • Medical expenses outside the U.S.
  • Prescription medications

In addition to the items and services listed above, Medicare doesn’t pay for anything your client’s doctors consider medically unreasonable and unnecessary services and supplies to diagnose or treat their specific conditions. Medicare also doesn’t cover hospital services that exceed length-of-stay limitations, and it only covers the first 20 days in a Skilled Nursing Facility.

If your client requires a service not covered by Medicare, they can pay out of pocket or obtain another insurance plan or Medicare policy that can help pay for their needs.

Other Options: Filling the Gaps in Medicare Coverage

While Medicare parts A and B don’t cover everything, there are options to take care of some or all of your client’s out-of-pocket costs.

Medicare Part C, or a Medicare Advantage plan — offered by Medicare-approved private companies — often covers items and services not covered under Original Medicare.

Medicare Part D plans can save your clients money on prescription drugs.

A Medicare Supplement, or Medigap plan, can also help cover some of the services not covered under Original Medicare. Just remember, your clients won’t be able to enroll in or use a Medigap plan if they’re also under a Medicare Advantage plan.

Check Medicare.gov to see if the test, item or service your client needs is covered by Medicare.


LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.