What Services Aren't Covered by Original Medicare?

Original Medicare is NOT an all-inclusive health insurance plan.

When deciding how to get your Medicare benefits, it is important to understand what services ARE covered and what services are NOT.

Some of the items and services that are NOT covered by Original Medicare include:

• Dental exams, most dental care or dentures
• Routine eye exams, eyeglasses or contacts
• Hearing aids or related exams or services
• Routine Physical Exams (but May be covered with Specific Diagnosis)
• Most care while traveling outside the United States
• Help with bathing, dressing, eating, etc. (custodial care)
• Comfort items such as a hospital phone, TV or private room
• Long-term care
• Cosmetic surgery
• Most chiropractic services ( but Does cover manual manipulation of the    spine if medically necessary to correct a subluxation)  
• Acupuncture or other alternative treatments
• Massage Therapy
• Routine foot care ( but Does cover medically necessary podiatrist services to treat foot injuries or certain diseases)   

While many Medicare Advantage plans have added services such as:

Basic Dental, Basic Vision and some Hearing benefits, Members of those plans should NOT necessarily expect comprehensive coverage or high dollar coverage for these services in all cases.

With Medicare Advantage, each plan is different (even within the same company), so be sure to carefully read the Summary of Benefits for each plan you consider. 

Never assume that everything is covered just because they advertise with the WORDS Dental or Vision or Hearing. Always ask for the details.

Note that there are 3 levels of Dental care: Preventive, Basic and Major.

Also remember that with Medicare Advantage, your benefits can change every year.

Note that Medicare DOES cover Cataract Surgery and related services when deemed Medically Necessary by your physician. This includes the removal of the cataract, basic lens implants, and one set of prescription eyeglasses or contact lenses after the surgery.

Private Policies:

To obtain Truly Comprehensive Dental Coverage that includes: 

• Bridges
• Crowns
• Full or Partial Dentures
• Full Mouth Extractions
• Root Canals

          As well as Basic and Preventive Services such as:

•  X-rays, Fillings, Extractions(other than full mouth)
• Exams and Cleanings

There are separate, private policies available through private insurance companies.

Some are just for Dental, while others combine Dental, Vision and Hearing services into one policy. 

Most plans will have a "waiting period" before Major Services become available, but the Basic and Preventive Services are often covered immediately with No "waiting period".

Plans will usually cover a greater percentage of dollar costs the longer you have the policy in force. 

Some plans require the use of a Network of Providers, while other plans are more flexible and allow policy owners to choose Any Provider.