10 Things Medicare Doesn't Cover

 

What is not covered by Medicare?  Getting a clear-cut answer may not be as simple as you would think.  Understanding what Medicare covers is even more complicated. So, a Ben Hamilton approach might help to resolve the confusion.  More specifically, a micro analysis of the coverage might better uncover what is not listed and therefore not covered.

Medicare.gov lists 10 items not covered. 

Some of the items and services Medicare doesn't cover include:

• Long-Term Care (also called custodial care)
• Most dental care
• Eye exams (for prescription glasses)
• Dentures
• Cosmetic surgery  
• Massage therapy
• Routine physical exams
• Hearing aids and exams for fitting them
• Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
• Covered items or services you get from an opt-out doctor or other provider (except in the case of an emergency or urgent need)

Kiplinger ads a few more items.  Nerdwallet mirrors these items.  Furthermore, the commercials these days twist and yet link so much together leading the trusting to believe they have coverage where they really don’t or have limited coverage which is even worse.

Long term care is today better defined as care for the long term.  In the past, long term care was done mainly in the nursing home, but People today prefer to stay at home, or anywhere besides the nursing home.  These could include not only your home, but also skilled nursing, assisted living, adult day care, and even some senior living facilities. So, while skilled nursing might be covered it might also not be covered.  If it is required by your doctor after a surgery, accident, critical event etc., it is generally paid by Medicare.  On the other hand, if it extended beyond the prescribed time, or later needed but not required for medical treatment, then you are subject to pay for it.  This is an example of correct but also misleading information.  For example, if you are no longer able to perform two or more of your activities of daily living, you may need custodial care. This is where someone comes into your home assisting you to the bathroom, to feed, yourself, bath, etc. It is not medically necessary, but you need it.  Unless a family member is available, a service that provides that type of care is an option for you.  They like to get paid for work done.

Dental, Vision, and Hearing is not provided by Medicare, but your Medicare Advantage plan may provide it.  What is important here is to know how much. If you have poor oral hygiene, you may need repeated dental care.  You may also need glasses, like me. The coverage available may surprise you. Finally, as you get older, hearing assistance may be required.  Quality hearing aids cost. Unlike durable medical equipment, you may be responsible for a larger portion of the payment.

Cosmetic and Massage therapy can be considered elective.  Since it is something, you choose, and don’t “need”, it is not considered “medically necessary” so it is not covered. Since it is not covered my Medicare, your plan doesn’t generally cover it. There may be exceptions, so it is important to read your policy.

Routine exams are not always necessary, but some plans may provide coverage to promote wellness.  Again, it is strongly suggested you read your policy or contact your provider for clarification.

Lastly, concierge care and care provided by a doctor who doesn’t accept Medicare assignment, are also not covered. Medical care for emergencies are generally taken case by case.  It should be obvious by now the general underlying question should be, “is it medically necessary”.  If not, you pay.