Original Medicare (parts A and B) does not cover all healthcare services, including vision, hearing, and dental care. However, Medicare Advantage (Part C) plans may offer coverage for some of these services.
Original Medicare includes Part A and Part B:
- Medicare Part A (hospital insurance) helps pay for inpatient care you receive in hospitals and skilled nursing facilities.
- Medicare Part B (medical insurance) helps pay for medically necessary outpatient and preventive healthcare, such as flu shots and screenings.
Original Medicare doesn’t cover everything. For example, dental, hearing, and vision care are not covered.
These coverage gaps can be filled with additional parts of Medicare, such as Medicaid, Medicare Advantage (Part C) plans, or a PACE (Program of All-inclusive Care for the Elderly) plan.
Glossary of common Medicare terms
- Out-of-pocket cost: This is the amount you pay for care when Medicare doesn’t pay the full cost or offer coverage. It includes premiums, deductibles, coinsurance, and copayments.
- Premium: This is the monthly amount you pay for Medicare coverage.
- Deductible: This is the annual amount you must spend out of pocket before Medicare begins to cover services and treatments.
- Coinsurance: This is the percentage of treatment costs you’re responsible for paying out of pocket. With Medicare Part B, you typically pay 20%.
- Copayment: This is a fixed dollar amount you pay when receiving certain treatments or services. With Medicare, this often applies to prescription medications.
1. Vision care
Original Medicare (parts A and B) does not cover:
With Original Medicare, you’ll pay 100% of the costs for the above vision services.
Does Original Medicare provide any vision coverage?
Following a Medicare-approved surgery for cataracts with an intraocular lens, Part B will cover one pair of prescription eyeglasses with standard frames or one set of prescription contact lenses.
After you’ve met your Part B deductible of $257, you’ll pay 20% of the Medicare-approved amount for each approved cataract surgery with an intraocular lens.
»Learn more: Type of lens Medicare covers for catract surgery
2. Hearing care
Original Medicare does not cover hearing aids or the hearing exams needed for prescribing and fitting hearing aids. You will pay 100% of the costs associated with hearing aids.
Does Medicare provide any hearing coverage?
Medicare Part B covers hearing and balance exams if your Medicare-enrolled doctor deems them medically necessary for diagnosis and treatment.
Medicare may also cover a yearly visit to an audiologist without an order from your doctor if you:
- have a chronic hearing condition, such as hearing loss that occurs over the course of many years
- have hearing loss following the surgical implantation of a hearing device, and need a diagnosis to determine the cause
After you’ve met your Part B deductible, you’ll pay 20% of the Medicare-approved amount for hearing services. If you’ve received services in a hospital outpatient setting, you’ll also pay a hospital copayment.
3. Dental services
Original Medicare doesn’t cover the following dental services:
You’ll pay 100% of the costs for the above non-covered dental services.
Does Medicare provide any dental coverage?
Original Medicare may provide dental coverage if you’re admitted to a hospital for a dental procedure or if the dental service is directly related to a covered medical treatment.
Examples of this include:
- an oral exam and dental treatment before getting a heart valve replacement or bone marrow, organ, or kidney transplant
- treatment for a mouth infection, such as a tooth extraction, before cancer treatment
- treatment for a complication you experience while receiving treatment for head and neck cancer
For inpatient hospital services and stays, you’ll pay:
- Days 1 to 60: $1,676 deductible
- Days 61 to 90: $419 each day
- Days 91 to 150: $838 each day while using your 60 lifetime reserve days
- After day 150: all costs
For Medicare-covered dental services, you pay 20% of the Medicare-approved amount after you meet your Part B deductible. If you receive the dental service in an outpatient hospital or other facility setting, you’ll also pay a copayment to that hospital or facility.
4. Foot care (podiatry)
Original Medicare only covers podiatrist foot exams or treatment if you have diabetes-related nerve damage or need medical treatment for foot injuries or deformities, such as:
After you’ve met your Part B deductible, you’ll pay 20% of the Medicare-approved amount for the medically necessary foot treatment noted above.
If your foot treatments occur in a hospital outpatient setting, you will also pay a hospital copayment.
»Learn more: Medicare coverage for foot care
5. Routine physical exams
Original Medicare does not cover routine physical exams.
Original Medicare does cover yearly wellness visits
If you’ve been enrolled in Medicare Part B for longer than 12 months, you can get yearly wellness visits to update your personalized health history and help prevent illnesses or disability.
A wellness visit is not a physical exam. Instead, your doctor will have you fill out a health risk assessment questionnaire. You and your doctor can use it to develop a personalized health plan.
At a wellness visit, your doctor will also:
- take routine measurements, such as your weight, height, and blood pressure
- review your medical and family history
- note your current prescriptions
- discuss advance care planning
- develop a checklist for preventive care, such as screenings and vaccinations
- perform a cognitive assessment to look for signs of dementia
- answer any questions you may have and provide healthcare advice
»Learn more: Medicare and annual physicals
6. Cosmetic (aesthetic) surgery
Original Medicare does not cover cosmetic surgery unless it’s performed due to an accidental injury or is needed to restore or improve the function of a malformed body part.
You will pay 100% for all non-covered cosmetic surgeries.
Procedures that may or may not be considered cosmetic
The following procedures are sometimes, but not always, considered cosmetic. If you’re considering any of the following, you’ll need to obtain prior authorization from Medicare to ensure coverage:
- blepharoplasty (eyelid surgery)
- Botox injections (to treat muscle spasms and twitches)
- panniculectomy (surgery to remove excess skin and tissue from the lower abdomen)
- rhinoplasty (surgery to change the shape of your nose)
- vein ablation (procedures to close off veins)
7. Chiropractic services
Medicare Part B covers manual manipulation of the spine by a chiropractor to correct a vertebral subluxation. A vertebral subluxation is when the joints of the spine don’t move properly, but the contact between the joints is still intact.
However, Original Medicare will not cover other services or tests ordered by a chiropractor, such as X-rays.
8. Massage therapy
Original Medicare does not cover massage therapy, even if it’s recommended by a doctor.
You will pay 100% for massage services.
9. Long-term care
Long-term care, also called custodial care, is not covered by Original Medicare or Medicare Supplement Insurance plans (Medigap). This includes medical and nonmedical care for people living with chronic illnesses or disabilities.
Non-covered services include:
- personal care assistance, such as help with dressing, bathing, and using the bathroom
- home-delivered meals
- adult day care, such as social activities, meals, and recreational activities
- home and community-based services, which are when services are delivered to the home or community rather than institutions
You might qualify for long-term care through Medicaid or PACE, or you can look into purchasing long-term care insurance.
It’s a good idea to start planning for long-term care in advance so you can maintain your independence while getting the care you need.
Does Medicare cover any type of long-term care?
Original Medicare covers certain types of extended healthcare after a qualifying inpatient stay in a hospital. Qualifying events might include:
- recovering from a serious health condition, such as a heart attack or stroke
- physical or occupational therapy after an injury or surgery
- recovery care that requires intravenous (IV) medications, such as after a severe infection
Medicare coverage for these events might include:
- up to 100 days at a skilled nursing facility after a hospital admission
- medically necessary in-home health services, such as part-time skilled nursing care or visits from a physical therapist
- hospice care
10. Overseas care
Original Medicare typically does not cover healthcare services when you’re traveling outside of the United States.
Some exceptions may apply. For example:
- Medicare Part B may pay for healthcare you receive aboard a ship within the territorial waters adjoining land areas of the U.S.
- You’re in the U.S. when a medical emergency occurs, but a foreign hospital that can treat your condition is closer than the nearest U.S. hospital.
- You’re traveling through Canada when a medical emergency occurs, and a Canadian hospital that can treat your emergency is closer than the nearest U.S. hospital.
- You live in the U.S, and a foreign hospital that can treat your medical condition is closer to your home than the nearest U.S. hospital (for both emergency and nonemergency services).
Medicare may also cover medically necessary ambulance transportation to a foreign hospital if you’re being admitted for a medically necessary, Medicare-covered inpatient hospital service.
Takeaway
Original Medicare (parts A and B) covers many healthcare needs. However, it doesn’t cover everything. Vision, hearing, and dental care are some of the services not covered.
If you need healthcare services that are not covered by Original Medicare, you might consider enrolling in a Medicare Advantage (Part C), Medigap, or PACE plan.
Talk with a doctor about your current and future healthcare needs. They can provide recommendations for the type of coverage that may best serve you.
