What Medicare Doesn’t Cover

What Medicare Doesn’t Cover

Original Medicare, which consists of Part A and Part B, covers your hospital and medical insurance needs. There are, however, noticeable gaps in coverage.

Dental, Vision, Hearing

Medicare does not cover routine care or equipment for your dental, vision, or hearing needs. That means you pay out of pocket for vision exams, contact lenses, eyeglasses, dentures, routine dental cleanings, hearing aids, and aid fittings.

Unless you have a medically necessary procedure, Medicare will not cover it.

Foreign Travel

Medicare does not offer coverage outside of the United States, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands except in a few specific instances. These include:

  • A medical emergency occurs in the U.S. and the nearest hospital is across the border
  • You are traveling from Alaska through Canada when a medical emergency occurs and the Canadian hospital is closer than the nearest U.S. hospital
  • You live in the U.S. and the closest hospital is a foreign hospital

Prescription Drugs

If you have Original Medicare without a Part D plan, you will owe the full cost of prescription drugs at the pharmacy. Medicare Part B only covers a limited number of outpatient drugs, including those infused through durable medical equipment or given in a hospital outpatient setting.

How Medicare Advantage Fills the Gaps

Medicare Advantage Plans, also known as Part C, are a more comprehensive option that you can choose to join once you are enrolled in Medicare. These plans offer the same coverage as Part A and Part B, with added benefits such as prescription drug coverage, dental, health, or vision plans, and sometimes subsidized gym memberships.

Additional coverage varies by plan, so check with the available plans to see what they offer. These plans are from private insurance companies approved by Medicare.

Importantly, Medicare Advantage plans have out-of-pocket maximum limits. Original Medicare has no limit on your out-of-pocket spending, which means you could pay thousands of dollars every year without relief. Once you have reached the maximum under a Medicare Advantage plan, you will not be charged for covered healthcare services.

To enroll in a Medicare Advantage plan, you must be enrolled in Part A and Part B and live within the plan’s service area.

The prescription drug coverage these plans offer is equivalent to Medicare Part D.

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Medicare Part D Coverage

To help cover the costs of Medicare, insurance companies offer standardized Medicare Supplement Plans. There are ten available plans, which help to pay for your out-of-pocket expenses from Part A and Part B.

These expenses can include:

  • Part A coinsurance and hospital costs
  • Part B copays and coinsurance
  • Blood (first three pints)
  • Part A hospice
  • Skilled nursing facility
  • Part A deductible
  • Part B deductible
  • Part B excess charges
  • Foreign travel emergency

Are you having trouble choosing a plan? We can help. Call the Texas Medicare Advisors at 512-900-3008.