What’s Not Covered By Medicare Part A & Part B?

Medicare Part A and Part B, also known as Original Medicare, do not cover all medical services, including hearing, dental, or vision. However, some Medicare Advantage plans may offer these benefits.

In general, Original Medicare does not cover:

• Prescription drugs

• Long-term care (such as extended nursing home stays or custodial care)

• Hearing aids

• Most vision care, notably eyeglasses and contacts,

• Most dental care, particularly dentures,

• Most cosmetic surgery

• Massage therapy

• Sterilization, including a hysterectomy (unless it’s deemed medically necessary)

• Medical marijuana

• Medical expenses outside the United States

Many retirees believe that Medicare pays the majority of healthcare costs.

In truth, there are significant coverage gaps in Medicare Parts A and B, sometimes known as Original Medicare.

There are certain exceptions, but beneficiaries should be informed of what Medicare does and does not cover in order to plan ahead.

A Medicare Advantage plan, also known as Part C, is a government-approved private insurance company that acts as an all-in-one alternative to Original Medicare.

Medicare Advantage plans must provide the same basic level of care as Medicare Parts A and B, but they can also bundle extra benefits into a single plan, such as prescription medicines, dentistry, vision, and hearing.

Coverage for these extra services, however, may be limited.

According to a November 2019 report by the Kaiser Family Foundation — a renowned charity focused on national health policy issues — the average person with Medicare coverage paid $5,460 out of pocket for health care in 2016.

However, there are two ways to obtain drug coverage.

A Medicare Part D prescription drug plan is available as a stand-alone option.

Prescription drug coverage is included in a Medicare Advantage plan.

Compare Part D and Medicare Advantage plans in your region using the Medicare Plan Finder.

Some outpatient medicines may be covered by Medicare Part B in certain circumstances.

Certain injectable osteoporosis medications and oral end-stage renal disease treatments, for example, are covered.

In most cases, medications covered by Medicare Part B are obtained in an outpatient environment at a doctor’s office or a hospital.

For authorized Part B medications provided in a doctor’s office or pharmacy, you’ll be responsible for 20% of the Medicare-approved amount, plus the Part B deductible.

Care for the elderly

Long-term care, such as extended stays in nursing homes and assisted living facilities, is not covered by original Medicare.

Custodial care — that is, assistance with activities of daily living such as dressing, eating, and bathing — is also not covered.

Long-term care is also not covered by Medicare Advantage plans.

For up to 100 days, Medicare will cover some costs at a skilled nursing facility. A short-term stay at one of these facilities must occur within 30 days of leaving the hospital and must be for the same disease or injury.

Dental, vision, and hearing health are all important.

Dental work, as well as routine vision and hearing care, is often not covered by original Medicare.

Routine dental treatment, visits, cleanings, fillings, dentures, and most tooth extractions are not covered by Original Medicare.

The same can be said for routine eye examinations. Generally, eyeglasses and contact lenses are not covered.

However, testing and treatments for certain serious eye problems may be covered by Medicare Part B, though you will still be responsible for a copayment and your Part B deductible.

Vision Care Covered by Medicare Part B

• Yearly eye exams for people with diabetes

• Glaucoma tests for people at high risk

• Macular degeneration tests and treatment

• Cataract removal surgery

• One pair of eyeglasses or one set of contact lenses after cataract surgery.

• Medical Insurance Outside of the U.S.

  Except in very limited instances, such as on a cruise ship within six hours of a U.S. port, original Medicare does not cover treatment outside the United States.

  Some Medicare supplement insurance policies, often known as Medigap, do, however, cover out-of-country medical expenses.

  Outside of the United States, Medigap plans C, D, F, G, M, and N provide overseas travel emergency health care coverage.

  This Is What This Medigap Plan Will Cover.

  If your foreign travel emergency occurs within the first 60 days of your vacation, you will be covered.

  After a $250 yearly deductible is satisfied, 80% of billed expenditures for some medically essential emergency care are covered.

  There is a $ 50,000-lifetime coverage cap.

  The average premium for Medigap coverage in 2020 was