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10 THINGS MEDICARE DOESN’T COVER
YOU’LL NEED TO PLAN TO PAY FOR SOME COMMON MEDICAL EXPENSES
--------------------------------------------------------------------------------
By
Dena Bunis
En español
Published April 11, 2023
/ Updated October 13, 2023
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Medicare covers the majority of older Americans’ health care needs, from
hospital care and doctor visits to lab tests and prescription drugs. Here are
some needs that aren’t part of the program — and how you might pay for them.
1. OPTICIANS AND EYE EXAMS
While original Medicare covers ophthalmologic expenses such as cataract surgery,
it doesn’t cover routine eye exams, glasses or contact lenses. Nor do
any Medigap plans, the supplemental insurance that is available from private
insurers to augment Medicare coverage. Some Medicare Advantage plans cover
routine vision care and glasses.
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Solution: For some people, it makes sense to buy a vision insurance policy for a
few hundred dollars a year to defray the cost of glasses or contact lenses.
2. HEARING AIDS
Medicare covers ear-related medical conditions, but original Medicare and
Medigap plans don’t pay for routine hearing tests or hearing aids.
Solution: If you are in a Medicare Advantage plan, check your policy to see if
it covers hearing-related needs. If it doesn’t, or if you have original
Medicare, consider buying insurance or a membership in a discount plan that
helps cover the cost of such hearing devices. Also, some programs help people
with lower incomes get needed hearing support. Or you can pay as you go.
Congress passed legislation in 2017 that allows some hearing aids to be sold
over the counter without a prescription. Medicare beneficiaries with mild to
moderate hearing loss can now buy hearing aids at drugstores and other retail
outlets without a prescription.
3. DENTAL WORK
Original Medicare and Medigap policies do not cover dental care such as routine
checkups or big-ticket items, including dentures and root canals.
Solution: If your MA plan doesn't include dental or you are enrolled in original
Medicare, consider buying an individual dental insurance plan or a dental
discount plan.
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4. OVERSEAS CARE
Original Medicare and most Medicare Advantage plans offer virtually no coverage
for medical costs incurred outside the U.S.
Health & Wellness
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Solution: Some Medigap policies cover certain overseas medical costs. If you
travel frequently, you might want such an option. In addition, some travel
insurance policies provide basic health care coverage — so check the fine print.
Finally, consider medical evacuation (aka medevac) insurance for your adventures
abroad. It’s a low-cost policy that will transport you to a nearby medical
facility or back home to the U.S. in case of emergency.
5. PODIATRY
Routine medical care for feet, such as callus removal, is not covered. Medicare
Part B does cover foot exams or treatment if it is related to nerve damage
because of diabetes, or care for foot injuries or ailments, such as hammertoe,
bunion deformities and heel spurs.
Solution: If you face these costs, you may want to set up a separate savings
program for them.
6. COSMETIC SURGERY
Medicare doesn’t generally cover elective cosmetic surgery, such as face-lifts
or tummy tucks. It will cover plastic surgery in the event of an accidental
injury or if needed after another treatment, such as breast reconstruction
following a mastectomy.
Solution: If you face these costs, you also may want to set up a separate
savings program for them.
7. CHIROPRACTIC CARE
LIMITED ACUPUNCTURE COVERAGE
Medicare has added coverage for acupuncture for enrollees with chronic low-back
pain. Beneficiaries who have had lower-back pain for 12 weeks or longer will be
able to get up to 20 acupuncture treatments each year.
Allowing doctors, physician assistants, nurse practitioners and other qualified
personnel to provide acupuncture to these beneficiaries is one alternative,
federal officials say, to the increasing use of prescription opioids to handle
chronic pain.
Original Medicare does not cover most chiropractic services or the tests that a
chiropractor orders, including X-rays. Medicare Part B does pay for
one chiropractic service: manual manipulation of the spine by a chiropractor or
other qualified provider to correct a vertebral subluxation, which is basically
a partial dislocation of a spinal vertebra from its normal position.
Solution: Some Medicare Advantage plans will cover chiropractic services, so
check with your plan. Some chiropractors offer payment plans to help you pay for
this care.
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8. MASSAGE THERAPY
Original Medicare doesn’t cover massage therapy, often used to help reduce
chronic pain, although research suggests it may provide short-term, but not
long-term, relief. When it comes to pain management, Medicare does cover
chiropractic care in certain limited circumstances (see above) as well as
physical and occupational therapy when prescribed by a doctor. Some Medicare
Advantage plans might cover some massage therapy. It’s best to call your plan to
find out if it does.
Solution: See whether your health care provider can recommend a pain management
strategy that Medicare does cover. If you are set on getting massage therapy,
the likelihood is you’ll have to pay for it yourself .
9. NURSING HOME CARE
Medicare pays for limited stays in rehab facilities — for example, if you have a
hip replacement and need inpatient physical therapy for several weeks. But if
you become so frail or sick that you must move to an assisted living facility or
nursing home, Medicare won’t cover your custodial costs. (Nursing homes average
about $90,000 a year for a semiprivate room and more than $100,000 for a private
room. Costs vary based on where you live and what facility you choose.)
Solution: Planning for nursing home care is a big issue, with lots of choices
and decisions. But for those with limited income and savings, Medicaid might
help fill in the gaps.
10. CONCIERGE CARE
Some physicians and their practices require a membership fee in order for them
to treat you. They advertise that this makes them more responsive and available
to their patients. The fees, which can run in the thousands of dollars a year,
vary depending on the concierge or boutique practice. Medicare will not cover
these fees. Note that once you’ve paid that fee, if your doctor participates in
Medicare he or she must offer all the services Medicare does with the same
copays and coinsurance rules applying.
Solution: You can either pay the fee or find another doctor. You might talk to
your physician about the terms of when you have to pay. Some states have laws
that provide consumer protections for these arrangements.
Editor’s note: This article has been updated with additional information.
%{postComment}%
Editor’s note: This article has been updated with additional information.
Dena Bunis covers Medicare, health care, health policy and Congress. She also
writes the “Medicare Made Easy” column for the AARP Bulletin. An award-winning
journalist, Bunis spent decades working for metropolitan daily newspapers,
including as Washington bureau chief for the Orange County Register and as a
health policy and workplace writer for Newsday.
What Doesn't Medicare Cover?
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Which path you take will determine how you get your medical care — and how much
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AARP Value & Member Benefits
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MEMBERS ONLY
Restaurants
Carrabba's Italian Grill®
10% off dine-in service or curbside carry-out orders
Learn More
See more Restaurants offers >
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MEMBERS ONLY
Travel
AARP Travel Center Powered by Expedia: Hotels & Resorts
Extra 10% off select hotels
Learn More
See more Travel offers >
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MEMBERS ONLY
Home & Real Estate
ADT™ Home Security
Savings on monthly home security monitoring
Learn More
See more Home & Real Estate offers >
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AARP MEMBERSHIP
Join or Renew Today
Save 25% when you sign up for automatic renewal
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234
*
*
*
*
* MEMBERS ONLY
Restaurants
Carrabba's Italian Grill®
10% off dine-in service or curbside carry-out orders
Learn More
See more Restaurants offers >
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Extra 10% off select hotels
Learn More
See more Travel offers >
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* MEMBERS ONLY
Home & Real Estate
ADT™ Home Security
Savings on monthly home security monitoring
Learn More
See more Home & Real Estate offers >
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* Health & Wellness
AARP® Staying Sharp®
Activities, healthy recipes, challenges and more through AARP Staying Sharp®
Learn More
See more Health & Wellness offers >
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