Benefits Medicare DOESN’T Cover

Medicare provides comprehensive coverage. However, there is still a long list of benefits NOT covered.

 Original Medicare

Original Medicare is comprised of two parts. Part A is your hospital insurance and Part B is your outpatient insurance.

Part A will help to cover:

• Inpatient procedures
• Nursing home care
• Skilled nursing facility care
• Home health care
• Hospice care

Part B will help to cover:

• Doctor’s visits
• Outpatient procedures
• Labwork and xrays
• Ambulance services
• Durable medical equipment
• Limited prescription drugs

***Part B covers insulin administered via pump, vaccines and cancer medications such as chemotherapy. 

There are also deductibles, copays and coinsurance. However, the benefits listed above are all covered by Original Medicare.

Unfortunately, that leaves many benefits which are NOT covered by Medicare.

Hearing

Surprisingly, hearing is a benefit not covered by Original Medicare. So, unfortunately hearing aids and fittings for hearing aids are entirely out of pocket. However, this may change in the near future. Currently, the only Medicare solution to hearing benefits is Medicare Advantage. 

Long Term Care

Medicare covers skilled nursing facility care. This is not the same as an assisted living facility or long term care. Skilled nursing facility care is for short term, recoverable illness or injury. A long term condition, like Alzheimers, would disqualify you.  There are, however, such things as long term care plans. These types of facilities can be rather expensive without coverage. This benefit is not covered by Original Medicare.

Vision & Dental

Vision and dental are also not covered. Most likely, you’ll need these types of benefits. Prescription glasses are not covered. Most seniors will need some type of vision care. Dental care is also not covered. Neither original Medicare nor a Medigap plan will cover these benefits. Often Medicare Advantage plans do offer vision and dental.

However, separate dental and vision plans can be rather inexpensive. It may behoove you to purchase a separate plan.

Prescription Drugs

Original Medicare doesn’t cover prescription drugs. There are limited exceptions to this. But for your basic prescriptions such as daily medications for blood pressure or antibiotics, you will need additional coverage. Again, many medicare advantage plans will cover prescription drugs. If you keep Original Medicare, even with a Medigap Plan, you will need Medicare Part D.  

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