What Medicare Covers And Doesn’t Cover?

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Lauren Lewthwaite 05-08-2021

What Is Covered And Not Covered By Medicare?

What Does Medicare Covers - Consumercoverage

Medicare gives people aged 65 and older access to basic healthcare coverage, but it certainly isn’t comprehensive. If your plan is to rely on Medicare as you get older, it’s crucial to understand what Medicare covers you for — and where it falls short. 

Keep reading to find out exactly what is covered and not covered by Medicare so you can start to prepare financially or by purchasing supplemental coverage. 

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What Is Medicare & What Does It Cover?

Medicare is a federally run health insurance program designed to give people aged 65 and older (with some exceptions) access to healthcare. Healthcare is a pretty broad term though, which is why Medicare is broken down into four parts:

  • Part A: This covers hospital stays, stays in a skilled nursing facility, hospice, and some home care. 
  • Part B: This covers doctor’s visits, outpatient care, medical supplies, and some preventative services.
  • Part C: This is Medicare Advantage, optional, additional insurance that offers private health insurance. 
  • Part D: This is prescription drug coverage.

You can enroll in one or all parts of Medicare, but parts A and B are the most common. Enrollment by age 65 is mandatory, unless you already have an accepted coverage like your employer’s health insurance plan. 

The Cost of Medicare

Although a federally run and funded program, Medicare is unfortunately not free. Everyone must pay a monthly premium if they’re enrolled, although this varies significantly based on coverage and income. It’s also important to note that what Medicare doesn’t cover are co-pays and deductibles, which are paid out of pocket unless you purchase a Medicare supplement like Medigap to help with those costs

Medicare can seem expensive, but it’s important to ensure you’re enrolled and covered prior to needing coverage, because at that point, paying out of pocket can be financially devastating. 

What Medicare Does Not Cover?

Medicare is often essential healthcare for many, but before enrolling it’s important to know what Medicare does not cover so that you can start planning financially or find a plan to supplement it (while you’re still healthy). These gaps in Medicare include:

  • Dental care: Routine dental care like teeth cleaning, fillings, x-rays and more aren’t covered under Medicare. 
  • Long term care: Having a long term care plan is essential, because Medicare does not cover stays in retirement facilities. While skilled nursing services are often covered, services like assisted dressing, bathing, feeding and more are not.
  • Vision care: Routine vision care like eye exams and prescription glasses are not covered under Medicare.
  • More: Hearing aids, medical care overseas, prescription drugs (unless you’re enrolled in Part D), dentures, cosmetic surgery, acupuncture, routine foot care. 

Knowing what is covered and not covered by Medicare can help you decide what level of enrollment in Medicare you need and whether to purchase supplemental plans. It also can help you financially plan for the services that you may need to pay out of pocket.

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Surprising Services Medicare Does Cover

Medicare has five different parts to it, which gives you options for your coverage. But it also covers certain services you might not have expected, such as:

Part A:

  • Walkers and wheelchairs 
  • Blood transfusions
  • Certain home care services
  • Stays of three consecutive days in a skilled nursing facility (if prescribed by a doctor)

Part B:

  • Screening tests for cancer, diabetes, depression, and more
  • Ambulance services
  • Certain vaccinations like influenza and hepatitis
  • Some medical equipment
  • Supplies for managing diabetes

For those without healthcare coverage, Medicare can be essential and these covered services help show why. Without Medicare, these would be all paid for out of pocket if needed, which can be financially straining for many — in fact, just paying for an ambulance ride out of pocket can cost hundreds to thousands of dollars). 

The Bottom Line

Medicare is not the most comprehensive healthcare coverage, but it does cover the basics which are needed by many. Understanding what Medicare does and doesn’t cover prior to enrolling or prior to needing the services can help you be most prepared.

Lauren LewthwaiteLauren Lewthwaite has been freelance writing for almost five years writing content that ranges from health to insurance and everything in between. Lauren is also a trained translator in French and English and is a dog-mom to an adorable Australian Shepherd.