What Does Medicare Cover And Not Cover?
Updated for January, 2022
- Original Medicare does not cover long-term/custodial care, dental care and dentures, hearing aids and related exams, and more.
- Medicare Part D is optional prescription drug coverage to anyone with Medicare. Each plan’s standard level of coverage includes anticancer, anticonvulsant, antidepressants, antipsychotics, antiretrovirals and immunosuppressants.
- Medicare Advantage plans cover services not included in Original Medicare, including hearing aids, dental care and eye exams.
Most people assume their Medicare policy will cover all of the healthcare needs they have. But this isn’t always the case. If you want to protect your health as you age, learn what is covered under Medicare and what your options are for additional coverage.
What Does Original Medicare Cover?
Original Medicare includes Part A hospital insurance and Part B medical insurance. It can be used at virtually any hospital or medical clinic in the United States. Coverage is determined by federal and state laws.
Services covered under Original Medicare must be either:
- Medically necessary – Needed to diagnose and treat your medical condition and part of standard practices
- Preventive – To prevent an illness or detect a condition at an early stage when treatment will be more effective (typically applies to Part B)
|Part A||• Hospital stays • Skilled nursing facility care • Hospice care|
|Part B||• Select doctors’ services • Outpatient care • Medical supplies • Preventive care • Mental health • Ambulance services|
Original Medicare includes Part A hospital insurance and Part B medical insurance and can be used at virtually any hospital or medical clinic in the US.
What Does Medicare Part A and B Not Cover?
Unfortunately, Parts A and B do not cover everything. Some tests, items and services are not covered, including:
- Long-term/custodial care
- Dental care and dentures
- Eye exams related to eyeglass prescriptions
- Hearing aids and related exams
- Take-home prescription medications
- Routine foot care
- Cosmetic surgery
Services not covered by Original Medicare will have to be paid 100% out of pocket, unless you have other insurance or an alternate Medicare health plan to cover them.
What Does Medicare Part D Cover?
Medicare Part D, or Medicare prescription drug benefit, is optional coverage available to anyone with Medicare. With Original Medicare, you can enroll in a standalone Part D prescription drug plan (PDP).
PDPs are required to offer a standard level of coverage, as defined by Medicare. Plans must cover all drugs in the following categories:
Private insurance companies must also publish a drug formulary, which is a list of prescription drugs covered by their Part D plans.
What Medication Does Medicare Part D Not Cover?
Since Part D is offered by private insurance companies, coverage varies beyond the standard levels defined by Medicare.
Specific types of drugs are not included in Medicare coverage by law. Among those are:
- Drugs that treat weight loss and gain, and anorexia
- Drugs that help with hair growth or for other cosmetic purposes, though treatment for acne, psoriasis, rosacea, or vitiligo are not considered cosmetic and are covered by Part D
- Fertility drugs
- Erectile dysfunction drugs
- Drugs that help with a cold or cough symptoms
- Over-the-counter non-prescription drugs
- Prescriptions vitamins and minerals
Learn more about Part D coverage and your options before choosing the right plan for you.
Medicare Part D, or Medicare prescription drug benefit, is optional coverage available to anyone with Medicare.
How Can You Get Additional Coverage?
If you need coverage for services that aren’t included in Original Medicare, including hearing aids, dental care and eye exams, you have options.
Medicare Advantage plans, or Medicare Part C plans, provide more comprehensive, bundled coverage. These health plans are offered through private insurance companies, and typically include coverage for vision, hearing, dental care and prescription drugs.
Coverage for Part C plans can vary, however, depending on the private insurance carrier. It is a good idea to shop around and find the best Medicare Advantage plan for your health care needs.
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