8 Surprising Services that are NOT Covered Under Original Medicare

Medicare provides essential health coverage for millions of Americans and covers a wide range of medical services, hospital stays, and preventive care.

Medicare Part A and Medicare Part B collectively are referred to as “Original Medicare”. Generally speaking, Part A covers hospital care, skilled nursing, hospice, and some home health care. Part B covers outpatient services like doctor visits, therapy, and ambulance services, among other things.

While the coverage under “Original Medicare” is quite comprehensive, it does not cover everything and knowing what is and is not covered is vital when planning your transition to Medicare. Below are eight things that many beneficiaries are surprised to learn are NOT covered under Original Medicare.

8 Surprising Services that are NOT Covered Under Original Medicare

1. Dental Care

Original Medicare does not offer coverage for dental cleanings, exams, fillings, root canals, dentures, or any other dental service. There are “Medicare Covered” dental services, but they are very limited and are typically related to a medical issue. For example, if you’re in a car accident and some of your teeth are knocked out, Medicare may provide some coverage if the procedure needed is deemed “medically necessary.”

2. Eye Glasses / Contact Lenses

Unfortunately, routine eye exams for eyeglasses or contact lenses are not covered under Original Medicare. There are some very limited circumstances where exams, corrective lenses, and glasses will be covered. Medicare will cover eye exams for diabetic retinopathy once per year if you have diabetes. Medicare will also cover one pair of eyeglasses with standard frames (or one set of contact lenses) after each covered cataract surgery that implants an intraocular lens.

3. Hearing Aids

Medicare does not cover hearing aids or exams for fitting hearing aids, and this is unfortunate because they can be very costly! However, Medicare will cover diagnostic hearing and balance exams if your doctor orders them to determine if you need medical treatment. 

4. Routine Physical Exam

Medicare will cover an Initial Preventive Physical Exam (IPPE), also known as a “Welcome to Medicare” preventive visit within the first 12 months of being on Medicare, but it does not cover an annual physical exam. This “Welcome to Medicare” visit promotes good health through disease prevention and detection and includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services. If you’ve had Medicare Part B for more than 12 months, Medicare will  cover an annual “Wellness Visit” to develop or update your personalized plan to help prevent disease and disability, but it is not a “physical” exam; there is no bloodwork, urine collection, or other services that are often included in a physical. 

Truman’s Tip:

Medicare’s free “What’s covered” app delivers accurate cost and coverage information right on your mobile device! “What’s covered” is available for free on both the App Store and Google Play. Search for “What’s covered” or “Medicare” and download the app to your mobile device.

5. Prescription Drugs

Original Medicare does NOT cover prescription drugs that you fill at a pharmacy and take on your own. These types of medications fall under Medicare Part D, not Original Medicare (Parts A and B). In order to get prescription drug coverage, you will need a stand alone Prescription Drug Plan (PDP) or a Medicare Advantage Plan where the prescription drug coverage is embedded (MAPD). I should note that Medicare will cover Part B drugs (usually at 80%), which are injectables and infusions that are administered in a provider’s office (e.g. chemotherapy, radiation, etc). 

6. Long Term Care / Custodial Care

Long-term care involves a wide variety of support services to help people live as independently and safely as possible. Most long-term care is not medical care; instead, it’s care that helps with basic personal tasks of everyday life known as “Activities of Daily Living/ADLs” (think bathing, eating, dressing, etc.) and it can be administered in an assisted living facility, nursing home, in the community (adult day care centers, for example) or at home. Unfortunately, Long Term Care is not covered under Original Medicare and you may want to consider a Long Term Care policy to cover you in the event that you need this type of care in the future.

7. Cosmetic Surgery

Medicare does not cover cosmetic surgery, except in very rare circumstances. Medicare may help cover cosmetic surgery if it’s needed because of accidental injury or to improve the function of a malformed body part. They will also cover breast prostheses for breast reconstruction if you had a mastectomy due to breast cancer.

8. Massage

Massage therapy has many benefits, but unfortunately, it’s not a Medicare covered service. If you want to receive massage therapy, you will need to self-pay.

Summary

While Medicare provides critical coverage for many services, it's important to be aware of the items that are not covered and it’s also imperative that you understand your own individual needs! Do you need a dental crown or other service? Do you anticipate needing hearing aids? Do you wear glasses or contacts and that coverage would be helpful for you? Although these items are not covered under Original Medicare, there are options for coverage through stand alone policies or coverage options that do have some coverage for these items. Contact Care Compass today to schedule your “Care at No Cost” consultation so we can determine your needs and make sure you have the coverage that you need!

Care Compass is an independent insurance agency that helps seniors navigate the complexities of Medicare and other Senior Products. Our goal is to empower Medicare-eligible individuals to make educated and informed decisions about their healthcare. Our services are offered at NO COST to you. Care Compass is proudly owned and operated in Duncansville, Pennsylvania and we serve the residents of Blair County and the surrounding region. If you need Medicare assistance near Altoona, PA, contact us today!