Medical Services Medicare Doesn't Cover
While Medicare covers a wealth of preventive and medically necessary doctor's visits and procedures, there are some common medical services Medicare don't cover or covers only under specific circumstances. "Medicare doesn't cover eyeglasses, hearing aids or dental benefits," says Juliette Cubanski, a Medicare policy analyst at the Kaiser Family Foundation. "If you don't have supplemental coverage, then most people who need those services would end up having to pay out of their own pocket." Here are some common medical services many older people need that traditional Medicare won't pay for:
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Eye exams. Most Medicare beneficiaries are eligible for a simple vision check at preventive care visits, but Medicare doesn't cover routine eye exams for eyeglasses or contact lenses. However, some preventive and diagnostic eye care services are available to Medicare Part B recipients, including tests for glaucoma and macular degeneration. And people who have diabetes are eligible for an annual eye exam for diabetic retinopathy.
Eyeglasses. Although huge numbers of seniors need glasses or contacts to see clearly, Medicare typically won't pay for them. "For the Medicare population, things like eyeglasses are something that most of them are using," says Allison Hoffman, an assistant professor of law at the UCLA School of Law. "Most people pay for those out of pocket." However, for seniors who have cataract surgery that implants an intraocular lens, Medicare Part B will chip in for one pair of eyeglasses or one set of contact lenses.
Dental care. Medicare doesn't cover routine dental care, including cleanings, fillings and tooth extractions. The health plan also won't pay for dentures or dental plates. However, Medicare Part A might pay for certain dental services you get while hospitalized during an emergency.
Hearing aids and exams. Medicare Part B covers diagnostic hearing and balance exams that are ordered by a doctor to access function, but it won't cover routine hearing exams. Hearing aids and the exams for selecting and fitting an appropriate hearing aid are also not covered by Medicare.
Cosmetic surgery. Medicare doesn't cover cosmetic surgery unless the procedure is needed because of an injury or illness. For example, Medicare will cover a breast prostheses if you had a mastectomy due to breast cancer.
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Acupuncture. Medicare will not cover this form of traditional Chinese medicine that involves sticking needles into the skin at specific points on the body.
Routine foot care. Medicare Part B covers podiatrist services for the treatment of foot injuries or diseases, such as hammer toes, bunion deformities and heel spurs. Foot exams and treatment are also covered if you have diabetes-related nerve damage. However, routine foot care, including the cutting or removal of corns and calluses or preventive maintenance of the feet, won't be paid for by Medicare.
Long-term care. Medicare Part A covers care in a skilled nursing facility only after a three-day inpatient hospital stay. And retirees are limited to 100 days of covered care, after which the Medicare beneficiary becomes responsible for all costs. For people with low incomes and assets, Medicaid will pay for some forms of long-term care, including nursing home costs. People with assets to protect may want to purchase a long-term care insurance policy to help defray potential nursing home costs. "If you're of moderate income, you probably should get long-term care insurance before you get into your old age," says John Palmer, a Syracuse University professor and former public trustee for the Medicare and Social Security programs. "If your means are modest, you are going to spend down your assets and become eligible for Medicaid, so it probably doesn't make a lot of sense to spend money on insurance. And if you are very well off, you can self-insure. But for the broad band of people, the only way to protect your savings and assets from a high long-term care cost is to insure."
Medical care outside the U.S. Medicare typically won't pay for health care received while traveling outside the U.S. However, there are a couple of exceptions where Medicare will pay for services received in a foreign hospital. For example, if you're in the U.S. but a foreign hospital is closer than the nearest U.S. hospital, Medicare will cover the services received there. Or if you're traveling through Canada between Alaska and another state when a medical emergency occurs, a Canadian hospital can be used to treat the emergency. Services you get while on board a ship in the territorial waters adjoining the U.S. are also covered.
[Read: How to Budget for Health Costs in Retirement.]
Retirees may be able to get coverage for some of these common medical services by purchasing supplemental insurance, such as a Medigap or Medicare Advantage plan. "Some of the Medigap and Medicare supplement plans and Medicare Advantage plans might offer some vision coverage or hearing aids or things like that as part of supplemental coverage, but outside of Medicare," says Jack Hoadley, a health policy analyst at Georgetown University. "That is part of something you are paying extra for in premiums." Without additional coverage, you will likely need to pay for eyeglasses, hearing aids and dentures out of pocket throughout your retirement.
