What Original Medicare Does Not Cover

Medicare is one of the most successful social programs in the country's history.  Currently, over 67 million Americans are insured for hospital, medical, and prescription coverage through Medicare.  The program has evolved over the years to include more medical services but each addition requires an act of Congress to fund.

Most recently, Original Medicare (Part A & B) began paying for acupuncture (with limitations), telehealth services, and more mental health services.  Unfortunately, Original Medicare still do not cover several areas that may be covered by traditional employer-based insurance plans or Affordable Care Act insurance plan.  Many Medicare Advantage plans (Medicare Part C) will include supplemental benefits that Original Medicare does not cover, but they vary greatly from plan to plan. It's wise to consult your Medicare Insurance Broker to understand the plans and benefits available to you. 

Below is an overview of some areas that are not covered by Original Medicare:

Dental

Dental expenses can be astronomical and the only time Medicare will pay for dental care is if it is necessary for a covered medical procedure such as a organ transplant or medically necessary dental care when you’re admitted to a hospital.  The cost to add dental to Medicare is not budgeted for.  If you would like to purchase a private dental plan you can find more information about options by clicking here.

 

Eye Glasses

Medicare will pay for eye conditions and for a pair of glasses after cataract surgery but it doesn’t pay for routine eye glasses or contact lenses.

 

Long Term Care

Nursing Home Care are generally not covered by Medicare. Individuals that qualify for Medicaid can have it paid.  Long Term Care insurance is a product that can be purchased separately which will pay for either a nursing facility or at home care.  Applicants will have to health qualify to purchase Long Term Care insurance and there is a significant premium for the coverage. 

Medicare will pay the first 20 days in a nursing home after a 3-day hospital stay.  Between days 20-100 there is a $204 daily fee then Medicare stops paying after day 100. 

Home Health services can be covered on a part-time basis and the Medicare beneficiary is “homebound”. The home health services include therapy and other medical care but do not cover custodial care.

 

Hearing Aids

Although loss of hearing can cause other mental and physical issues, Medicare does not pay for hearing aids.  Some hearing aids are now available over the counter.  Assistance programs are available to income-eligible individuals in New Jersey through the Division of the Deaf and Hard of Hearing.  

 

Cosmetic Surgery

The only time Medicare will pay for cosmetic surgery is to correct a malformed body part or treat complications from an accidental injury.  For example. Medicare will cover breast reconstruction surgery after masetecomy due to breast cancer. A Rhinoplasty procedure (nose job) may be covered if it is causing nasal obstruction, while skin infections may be treated by lipectomy.  Any covered procedure will require "Prior Authorization" by Medicare before the procedure.

 

Vitamins & Supplements

Medicare does not pay for over the counter items and even some ohysician prescribed vitamins are not covered.  Some of these include Armour Thyroid, Vitamin D, Vitamin B. When in doubt, ask your broker to review these medications each year prior to enrolling in a drug plan.

New Jersey Medicare Brokers can help!

Please contact us with any questions related to what Medicare doesn't cover by visiting our website or calling 800-797-0605 for assistance.