Services Not Covered by Original Medicare That You Must Know

Services Not Covered by Original Medicare That You Must Know

Medicare is perfect healthcare coverage for many beneficiaries. However, some still find it insufficient in many instances and have to enroll in other programs to keep themselves covered. The reality is Medicare doesn’t cover everything, and that’s why beneficiaries have to look for options other than Original Medicare.

Original Medicare has two parts, Part A and Part B. Part A covers hospital insurance and Part B covers medical insurance.

Since every individual has different medical needs, they have different medical requirements as well. And that’s why you need to know what services Original Medicare covers and what you need to purchase separately.

Doesn’t Cover Long-Term Care

Long-term care is the most likely cause of making a hole in your retirement savings. And since Medicare does not provide custodial or long-term care, such as assisting in bathing, dressing, and other activities, you have to purchase a different plan that supports the benefit or cover the respective costs for you.

Doesn’t Cover Dental Care

Original Medicare does not cover your regular dental visits, X-rays, teeth cleanings, fillings, tooth extraction, or any dental care. Unfortunately, many beneficiaries don’t pay attention to it before enrolling and may pay for their dental visits from their pocket.

You can enroll in another private dental insurance policy to get coverage if you often require dentist visits. Another option is to build a surplus in an HSA (health savings account) until you apply for Medicare. Notably, you cannot make new contributions into an HSA after enrolling in Medicare.

Medicare Advantage, i.e., Part C, also provides you dental care coverage, such as cleanings and X-rays.

Doesn’t Cover Vision Care

Vision and Dental care work in similar ways, and Medicare does not cover any of these — not even routine eye examinations. 

However, in some cases, you can get an annual eye examination if you have diabetes or a pair of prescription eyeglasses if you have certain kinds of cataract surgery. Medicare can also assist if your eyes get damaged in an accident or injury.

But it is still different from regular vision checks and corrective glasses’ coverage — which Medicare does not provide. You can leverage an HSA before enrolling in Medicare to support your dental or vision checkups. Or you can buy a separate vision coverage or enroll in Medicare Part C that supports vision care.

Doesn’t Cover Hearing Aids

Medicare doesn’t cover any hearing examinations or hearing aids, or any exams for fitting hearing aids. However, you can buy a separate plan covering your hearing aids and examinations. As an alternative, an HSA can also cover the costs of aids and other expenses.

Some Medicare Advantage plans cover your hearing aids and fitting exams, and so they are also a great option. In addition, you can consult private insurance agencies as these plans are usually provided by them.

Our licensed agents specializing in Medicare can assist you in assessing your medical needs to provide suitable coverage.

Doesn’t Cover Prescription Drug

Medicare does not cover outpatient prescription drugs. And that’s why you will need a separate cover, i.e., Medicare Part D. You don’t need to enroll in Medicare Part D as you become eligible if you already have an employer’s plan that covers prescription drugs for you.

However, you must enroll within 63 days after your employer’s plan ends to avoid a penalty. You can also enroll in Medicare Part C, which provides prescription drug coverage with it, and it doesn’t allow you to enroll in Part D simultaneously. However, even if you do so, you will automatically be pushed back to Original Medicare.

Does Not Cover Cosmetic Surgery

Medicare does not cover cosmetic surgery unless it is prescribed. Prescribed cosmetic surgeries include accidental injury or to improve the abnormally formed body part. In addition, Medicare covers breast reconstruction in case of breast cancer.

Prior authorization for cosmetic surgeries, not intended for beauty purposes, is necessary for Medicare to pay for it. Fortunately, you don’t need to do anything. Instead, your provider will send the authorization request to Medicare, and once it is approved, you can be assured that Medicare will pay some part, if not total.

Doesn’t Cover Overseas Medical Care

Medicare doesn’t provide overseas medical care, and choosing a suitable plan is necessary if you often visit outside the U.S. 

However, there are some exceptions where Medicare can support limited care even when outside the U.S.

  • Medicare will compensate for emergency services in Canada if you are traveling a direct route between Alaska and another state without unreasonable delay, and the closest hospital that can treat you is in Canada.
  • Medicare would pay for the medical care you get on a cruise ship if the ship is in U.S. territorial waters. The provided services will not be covered under Medicare if a cruise is more than 6 hours away from a U.S. port.
  • In limited situations, Medicare may pay for non-emergency inpatient services in a foreign hospital (and any connected provider and ambulance costs). Your care is covered if the hospital is closer to your residence than the nearest available U.S. hospital. It is applicable if, for example, you live near the border of Mexico or Canada.

Notably, some Medigap policies provide coverage for travel abroad. For example, Medigap plans C through G, M, and N cover 80% of the cost of emergency care abroad. Medicare Advantage Plans may also cover emergency care abroad.

Doesn’t Cover Routine Physical Checkups

Medicare does not cover comprehensive physical checkups but provides “Welcome to Medicare” Preventive Visits and AWV (Annual Wellness Visit), entirely different from routine physical checkups.

Under comprehensive checkups, your body gets checked from head to toe, including measuring your blood pressure, heart rate, temperature and even conducting blood and urine tests in some cases. While AWV kicks in after 12 months of the beneficiary’s enrollment, including medical and family history review, developing or updating current providers and prescriptions, collecting routine measurements, etc.

On the other hand, “Welcome to Medicare” Preventive Visit is only available to newly enrolled beneficiaries once in the first 12 months, which includes a patient’s medical and social history review. Besides this review, it includes health risk screenings, flu shots, and referrals for other care.

There are many other services that Medicare does not provide, and that’s why it is necessary to sit down with experts and discuss your medical needs to find a suitable plan. Our licensed agents specializing in Medicare can help you with it. We can also help you enroll in Medicare Part C if any of your medical needs aren’t fulfilled by Original Medicare.

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