Medicare offers a broad range of essential services, but it doesn’t cover everything. Dental, vision care, and long-term assistance fall outside its scope. If you rely solely on Medicare, you could face unexpected out-of-pocket expenses. Here’s a look at what’s not covered and how you can prepare.
Hearing aids
Medicare excludes coverage for hearing aids and fitting exams, meaning beneficiaries must pay out of pocket. However, Medicare Part B does provide coverage for medically necessary hearing and balance exams, including an annual audiologist visit for specific conditions.
Some Medicare Advantage plans offer hearing aid benefits, and programs like Help America Hear and the Hearing Aid Project may assist with costs. Over-the-counter hearing aids, introduced in 2022, offer a more affordable option for people with moderate hearing loss.
Cosmetic Surgery
Original Medicare does not cover elective cosmetic surgery but may pay for procedures deemed medically necessary due to injury, illness, or congenital conditions. Breast reconstruction surgery after a mastectomy or rhinoplasty for breathing issues may qualify.
Some procedures, like Botox for muscle disorders or eyelid surgery for vision impairment, require prior authorization. Patients seeking purely aesthetic enhancements must cover all costs themselves.
Routine Eye Exams
Medicare does not cover routine eye exams, prescription glasses, or contact lenses. It does provide limited vision benefits in specific cases, such as a one-time vision test during the Welcome to Medicare visit and coverage for eye exams related to diabetes or cataract surgery.
Retirees can supplement coverage with Medicare Advantage plans, private vision insurance, or assistance programs like New Eyes and EyeCare America.
Dental services
Medicare doesn’t cover routine dental care like cleanings, fillings, extractions, or dentures. However, it provides coverage for specific medically necessary dental procedures related to organ transplants, heart valve replacements, and head or neck cancer treatments.
In 2024, coverage expanded to include dental treatments for complications after cancer therapies. Those seeking broader dental benefits can explore Medicare Advantage plans, private dental insurance, or assistance programs like the Dental Lifeline Network.
Foot care (podiatry)
Original Medicare covers medically necessary podiatry services, including foot fracture care, surgery for bunions or hammertoes, and wound treatment. It does not cover routine foot care like nail trimming or callus removal unless related to specific health conditions such as diabetes.
Medicare Advantage plans may offer additional podiatry benefits, so it’s worth checking individual plan details for broader coverage.
Chiropractic services
Medicare Part B covers chiropractic treatment only for vertebral subluxation, where spinal joints fail to move properly but remain intact. This coverage includes manual spinal manipulation but excludes X-rays, massage therapy, and acupuncture.
After meeting the Part B deductible, beneficiaries pay 20% of the Medicare-approved amount. Some Medicare Advantage plans may offer broader chiropractic benefits, including services not covered by Original Medicare.
Massage therapy
Original Medicare doesn’t cover massage therapy, even if prescribed by a doctor. However, it may be included as part of a broader treatment plan for physical or occupational therapy.
Some Medicare Advantage (Part C) plans offer massage therapy as a supplemental benefit, but coverage typically requires a doctor’s prescription and must be provided by in-network professionals. Beneficiaries should check individual plan details for availability.
Long-term care
Medicare does not pay for long-term custodial care, including stays in assisted living facilities or nursing homes. It provides limited coverage for skilled nursing facility care, up to 100 days after a hospital stay, home health services, and hospice care for terminal illnesses.
Medicaid, PACE, and private long-term care insurance can help cover costs for ongoing care needs, making early financial planning essential.
Routine physical exams
Original Medicare does not include routine physical exams but does offer annual wellness visits centered on preventive care. These visits include health assessments, screenings, and care planning but do not involve a full physical exam.
Seniors seeking full physicals may need a Medicare Advantage plan that covers them or pay out of pocket for individual exams.
Prescription Drugs
Though Medicare doesn’t include prescription drug coverage, beneficiaries have two options: Medicare Part D, a standalone prescription plan, or Medicare Advantage (Part C) plans that include drug benefits (MA-PDs).
Enrollment in both Part C and Part D is not allowed, so those seeking drug coverage must select a plan that includes it. Medicare drug plans charge separate premiums, making early selection critical for managing costs.
Overseas Care
While Original Medicare typically does not cover medical care outside the U.S., there are a few exceptions. In emergencies, coverage may apply if the nearest hospital equipped to treat you is located in another country—for instance, when traveling between Alaska and another U.S. state.
Additionally, Medicare may cover medical services received aboard a ship within six hours of a U.S. port. For broader protection while traveling, beneficiaries should explore Medicare Advantage plans with international benefits or travel insurance.
Concierge Care
Concierge care involves paying a membership fee for access to exclusive medical services, often beyond Medicare’s standard coverage. Medicare does not pay for concierge care fees, but participating doctors must adhere to Medicare rules.
While providers can charge for non-covered services, they cannot demand extra payment for Medicare-approved treatments. Those who don’t accept assignment may charge up to 15% more than Medicare’s approved amount for covered services.
