No one likes surprise bills, especially after turning 65. You’d think Medicare covers everything once you’re signed up, but that’s not the full picture. Some important services still come out of pocket, and knowing what’s left out can save you a lot of money and frustration down the line.
Here are a few medical costs that Medicare won’t cover.
Routine Eye Exams and Prescription Glasses
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Original Medicare doesn't cover routine eye exams for eyeglasses or contact lenses. However, it may cover one pair of eyeglasses with standard frames or one set of contact lenses after cataract surgery that implants an intraocular lens. For routine vision care, consider Medicare Advantage plans that offer additional benefits.
Long-Term Custodial Care
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Medicare does not cover long-term assistance with daily activities like bathing or dressing, whether in a facility or at home. It only covers short-term rehab after a hospital stay. To manage future costs, some people turn to Medicaid or invest in long-term care insurance early on.
Elective Cosmetic Surgery
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Medicare doesn't cover cosmetic surgery unless it's necessary due to an accidental injury or to improve the function of a malformed body part. For example, it covers breast reconstruction if you've had a mastectomy because of breast cancer. Elective procedures like facelifts or tummy tucks are not covered.
Massage Therapy
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Original Medicare doesn't cover massage therapy, even if it's part of a pain management routine or recommended by your doctor. However, some Medicare Advantage plans may include limited massage benefits. It's a good idea to review your specific plan or contact your provider to learn what's available.
Routine Physical Exams
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Routine physical exams aren’t included under Medicare coverage. It provides a one-time "Welcome to Medicare" visit and yearly wellness check-ins, both aimed at prevention and long-term health planning.
Hearing Aids and Fitting Exams
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If you're relying on Original Medicare, hearing aids and fitting exams won’t be included. To get help with those costs, look into Medicare Advantage plans that sometimes offer hearing-related benefits. For mild to moderate hearing loss, over-the-counter hearing aids are another option worth considering.
Concierge Care Membership Fees
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Concierge medicine, often called boutique or retainer-based care, comes with an annual fee that Medicare won’t cover. That out-of-pocket cost gives patients perks like longer appointments and round-the-clock access to their doctor. If you're considering this model, you’ll be responsible for the membership expense yourself.
Services from Opted-Out Providers
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If you receive services from a doctor or provider who has opted out of Medicare, Medicare won't pay for those services, except in emergencies. You'll need to pay the full cost yourself. Always check if your provider accepts Medicare before receiving services.
Most Dental Care
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Routine dental care isn’t part of Original Medicare, so things like cleanings, fillings, extractions, and dentures come out of pocket. In rare cases, coverage applies when dental work is tied to a covered medical procedure. Some Medicare Advantage plans include dental benefits, so review options carefully.
Routine Foot Care
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Standard foot maintenance, like trimming nails or removing calluses, isn’t paid for by Medicare. But if your doctor finds a medical issue, especially one tied to diabetes or an injury, treatment might be covered. It really just depends on whether the foot care is considered medically necessary, not just routine upkeep.
Medical Care Outside the U.S.
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Medical treatment outside the U.S. usually isn’t covered by Medicare. If you’re traveling, look into Medigap plans that offer emergency coverage abroad—often capped at $50,000 after a $250 deductible. Travel insurance is another option that can help with costs if you need care while overseas.
Acupuncture for Conditions Other Than Chronic Low Back Pain
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Medicare covers acupuncture for chronic low back pain, defined as lasting 12 weeks or longer without an identifiable cause. However, there is no coverage for other conditions. Some Medicare Advantage plans may offer broader acupuncture benefits.
Over-the-Counter Medications
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Medicare doesn't cover over-the-counter medications, including pain relievers, cold medicines, or antacids. Prescription drugs may be covered under Medicare Part D plans, but OTC drugs are typically paid out-of-pocket. Consider using health savings accounts (HSAs) or flexible spending accounts (FSAs) to offset these costs.
Hearing Exams Not Related to Medical Conditions
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Medicare covers diagnostic hearing and balance exams only if your doctor orders them to determine if you need medical treatment. It doesn't cover routine hearing exams for hearing aid fittings. Check with your Medicare Advantage plan for potential coverage options.
Alternative Medicine Treatments
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Medicare doesn’t include coverage for alternative treatments such as homeopathy, naturopathy, or herbal remedies. These options fall outside what Medicare considers standard medical care. However, certain Medicare Advantage plans may offer limited benefits for select alternative therapies, depending on the insurer and the plan’s specific offerings.
