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Sharp Health News

7 medical services Medicare doesn’t cover

Nov. 30, 2018

7 medical services Medicare doesn’t cover

Many Medicare beneficiaries need glasses and hearing aids, but Medicare typically won't cover these services. That's why Medicare Advantage plans — all-in-one alternatives to traditional Medicare — are worth considering.

Medicare and Medicare Advantage plans cover the same medical services, but certain Medicare Advantage plans provide extra benefits like vision or hearing for as little as $0 in addition to Part B and any other plan premiums.

Consider these seven common health care needs that are covered by some Medicare Advantage plans and not by traditional Medicare:

  1. Dental care
    Medicare does not cover most dental care, including dentures, fillings and routine dental cleanings. Medicare Part A may cover certain dental services received when you're in emergency inpatient care in a hospital.

  2. Hearing aids
    Original Medicare does not cover hearing aids or exams for fitting hearing aids. However, Medicare may cover hearing and balance exams if your doctor or other health care provider order them to see if you need medical treatment.

  3. Routine eye exams
    Eye exams to get eyeglasses or contact lens prescriptions are not covered by Medicare. Glaucoma tests, however, are covered once a year for people at high risk for this eye disease.

  4. Glasses and contact lenses
    Corrective lenses are a basic need for many older people and young people with disabilities, but Medicare does not cover their costs in most cases. If you have a cataract surgery that implants an intraocular lens, Medicare will cover one pair of eyeglasses with standard frames, or one set of contact lenses, from a Medicare provider.

  5. Foot care
    Medicare will cover medically necessary foot exams and treatment for people with diabetes-related nerve damage or certain other conditions. However, Medicare does not cover routine foot care such as corn and callus removal or nail maintenance.

  6. Care received outside the U.S.
    Medicare generally does not cover health care while you are traveling outside the U.S. There are a few rare exceptions. For example, Medicare may pay for services you get while on board a ship within the territorial waters adjoining the land areas of the U.S.

  7. Long-term care
    Medicare does not pay for long-term care, such as non-skilled personal assistance with everyday activities, and very few Medicare Advantage plans cover it. However, if you are enrolled in both Medicare and Medicaid (known as Medi-Cal in California), you may have coverage for long-term care. Visit longtermcare.gov for more information.

While Medicare Advantage plans are meant to be an all-in-one alternative to traditional Medicare, not all Medicare Advantage plans offer the same benefits for the same costs. Carefully review the details of any new health plan you're considering. In some cases, a Medicare Advantage plan may not be the right option to take. It's a good idea to get advice from experts:

Medicare: Call Medicare's help line at 1-800-633-4227 (TTY 1-877-486-2048) for general information and help with coverage.

Social Security: Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) for information and help signing up for Medicare or applying for Extra Help benefits in the Part D drug program.

State Health Insurance Assistance Program (SHIP): SHIP offers counsel and advice on Medicare and long-term care insurance. In California, the SHIP is called the Health Insurance Counseling & Advocacy Program (HICAP). Call HICAP at 1-800-434-0222 to find a location near you.

For local in-person assistance, Sharp Health Plan hosts free, informative one-hour seminars across San Diego County to help Medicare-eligible individuals and their friends and family learn about Original Medicare, Medicare Advantage plans, and prescription drug coverage. To attend an upcoming seminar, sign up at sharpmedicareadvantage.com.

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