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6 Health Services Not Covered by Medicare


Original Medicare covers many things, but not everything. These are the services that Medicare usually

doesn’t offer coverage for.

One of the things that makes Medicare such a useful healthcare solution for seniors and eligible

citizens is the comprehensive coverage that it offers. While this is an obvious plus, there are some

things that Medicare doesn’t usually cover. There are also some things that it only partially covers. We

talk a lot about what Medicare covers on Medicareful Living, but discussing what generally isn’t

covered is equally important, if not more important.

For this article, we’ll be focusing on Original Medicare. Since Medicare Advantage (Part C) plans can

have differing coverage from plan to plan, they may cover some of these entries in some way. If that’s

the case, we’ll make a note that it may be an option for you. Otherwise, if you think you’ll need one of

these services, you’ll want to look at the specifics of a certain plan to make sure it’s the right one for

you. If you have particular healthcare needs that relate to the items we’ll discuss below, it may also be

worth working with a licensed sales agent to find the plan for you or checking out our Medicareful Plan


Hearing loss is a condition about one in three seniors ages 65 to 74 around the country face. In fact, by

the time they’re 75, nearly half of all seniors experience some form of hearing loss. This can make

being able to get a hearing aid vital to maintaining a good quality of life. Unfortunately, Medicare rarely

covers hearing aids, hearing exams, and hearing aid fittings. Specifically, Original Medicare only

covers hearing aids if they’re bone-anchored hearing aids (BAHA), since those types of hearing aids

are now considered prosthetics and also rarely if ever, cover hearing aids.

Can I Get It Covered?

If you find yourself needing hearing aids, there are a few places you can turn. First, you can try a

Medicare Advantage plan. Many offer some form of hearing coverage, though you may still have some

out-of-pocket costs with a purchase. Medicaid may also offer hearing aid coverage, depending on the

state and if you qualify for coverage. Some private charities and associations, like the Starkey Group,

can offer financial aid. The Hearing Loss Association of America also offers information about how to

get financial aid for those in need. Finally, you can find a standalone dental, vision, and hearing

insurance plan to cover all three needs and supplement your Medicare coverage.

Routine Dental Work and Dentures

Speaking of dental coverage, routine dental work is not covered by Original Medicare. This means

you’ll likely be paying out of pocket for dentist visits, cleanings, and even dentures if you have

Medicare. The only way that Original Medicare may cover dental work is if it’s part of something that

Original Medicare normally covers, like surgery as part of inpatient care. In a circumstance where there is some coverage of dental care, a Medicare Supplement may help by possibly covering deductibles and coinsurances.

Can I Get It Covered?

Many Medicare Advantage (Part C) plans offer some form of dental coverage, though this differs from

plan to plan and is limited to certain services. Part C plans often will cover routine coverage like

checkups, preventative cleanings, and oral exams, to name only a few. However, this coverage

typically doesn’t extend, or fully extend, to some major dental procedures like crowns or dental items

like dentures. This can make reading the fine print of your Medicare Advantage plan very important. If

you want coverage for dentures or routine dental procedures, it may also be worth finding a standalone dental plan or a combination dental, vision, hearing plan.

Routine Vision Care

So, we’ve discussed dental and hearing, and how they’re generally not covered by Medicare. But, is

eye care covered? Unfortunately, that’s also a no, if you’re referring to routine care. Luckily, Original

Medicare does cover certain preventative and diagnostic exams for conditions like glaucoma, diabetes,

and macular degeneration. It can also cover things like medically-necessary cataract surgery.

However, services and checkups, like regular eye exams or glasses or contact lens fittings, generally

aren’t covered by Original Medicare. The same goes for Medigap plans, which do not cover routine

vision services. This means that 100 percent of the costs of these regular checkups and fittings will be

out-of-pocket expenses for you.

Can I Get It Covered?

Similar to dental and hearing, you can get many of your vision coverage needs in the right

Medicare Advantage plan. A large number of Part C plans cover vision benefits in some way, though the amount covered and the costs associated with this coverage varies between plans. While it doesn’t

cover the checkups, you can also get some vision coverage through Medicare Part D. This coverage is

largely related to vision medications and prescription eye drops and differs depending on the plan you

have. You can also get a stand-alone vision insurance plan or a combined dental, vision, and hearing

plan to help cover your vision needs.

Custodial Long-Term Care Services

There may come a point in your life when you require help with daily tasks beyond what your family

and friends can provide. You may eventually need long-term care services. If you need help with

everyday tasks like eating, washing, and dressing, this would be considered custodial long-term care.

Since this type of help is not considered medically necessary, Original Medicare won’t assist with

paying for this type of long-term care. It may assist with the costs of a skilled nursing facility,

like a semi-private room or prescription drugs, if they become medically necessary but the custodial

care is still your responsibility.

Can I Get It Covered?

Luckily, unlike other options in this article, there are ways to get help from Original Medicare for long-term care. If you qualify for PACE or hospice care, certain long-term care needs may be covered.

Original Medicare may also assist with long-term care hospitals or some home health services.

Medicaid can help cover some costs of long-term care as well. Alternatively, you can enroll in a long-term care insurance plan to have all your bases covered.

Cosmetic Surgery

Cosmetic surgery usually isn’t covered by Original Medicare. In fact, there are very few circumstances where cosmetic surgery is covered. Most cosmetic surgery is considered to be elective or nonessential surgery since it’s not medically necessary and is often done to fix a certain perceived physical

imperfection. This differs from plastic surgery, which is often focused on reconstruction or defects due

to birth disorders, trauma, or disease.

Can I Get It Covered?

The difference between cosmetic surgery and plastic surgery can make a large difference in your

coverage. Original Medicare will cover cosmetic or plastic surgery if it’s caused by an accidental injury

or to improve the function of a malformed body part. It may also cover breast prostheses if you’ve had a

mastectomy due to breast cancer. Some companies also offer cosmetic surgery insurance, though this

is rare and should be thoroughly researched before purchasing. The non-essential nature of most

cosmetic surgery procedures makes coverage for it rare, meaning you’ll likely be footing the entire bill.

Care Outside of the U.S.

Let’s say you’re on vacation and you get sick. You need health care. Does Medicare cover you? If you

happen to be inside the United States, generally speaking, you should be able to get coverage,

depending on the service. Original Medicare is accepted throughout the country. With Medicare

Advantage, the answer is a little murkier since they have plan networks. If you’re venturing outside of

the country, though, you won’t likely receive the same Medicare coverage you’re used to, if any.

Can I Get It Covered?

There are a few instances where Medicare can cover some of your expenses outside of the United

States, though they are very specific. These are:

  • If you have a health emergency in the U.S., but the nearest hospital that can assist you is in another country.
  • If you’re in Canada while traveling the most direct route between Alaska and the continental U.S. when the emergency occurs. In this case, a Canadian hospital must be the closest hospital and your trip must not be taking any “unreasonable delay[s].”
  • If you live in the U.S. and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition. In this instance, a medical emergency is not required for coverage.

Otherwise, you’ll likely be covering your own bills. You may be able to get a travel insurance plan,

though not all of them cover health care, so read the coverage closely before enrolling in a plan.

Finally, some Medicare Supplements and Medicare Advantage plans offer coverage for foreign travel,

which can be wise if you’re planning on traveling abroad.

Medicare, and specifically Original Medicare, covers many of the crucial healthcare needs of seniors

and eligible Americans around the country. But, it can’t cover everything. Luckily, if you do need one of

the health care services or items that aren’t traditionally covered by Original Medicare, there’s often a

way to get some financial assistance. This way, you can afford the care you need without your quality

of life is impacted. While this could mean that Medicare isn’t the only insurance you may need

depending on your circumstances, it’s good to know that there are options out there.

There is no better time to re-evaluate your current situation than the present. Connect with a licensed financial professional at Alfa Pride Financial, to assess where you are on your financial journey, and get the financial keys to a worry-free life.