7 Exclusions from Medicare

Medicare is the federal government's health insurance program for people 65 and older, as well as those with disabilities or chronic conditions. Here are seven items that Medicare does not cover:

1. Coinsurance And Deductibles

If you choose Original Medicare, you must pay deductibles and coinsurance for both Medicare Part A (hospital insurance) and Part B (medical insurance). If you have medical needs, this can get expensive, and there is no out-of-pocket spending limit on Original Medicare.

"Many people on traditional Medicare get a Medigap plan to help cover those costs and make their out-of-pocket costs more predictable," Gretchen Jacobson, vice president of Medicare for The Commonwealth Fund, a private foundation dedicated to promoting a high-performing health-care system, says.

If you enrol in a Medicare Advantage plan, which is provided by private insurance companies under contract with the federal government, you will be responsible for certain deductibles, copays, and coinsurance when seeking health care. Although Medicare Advantage has an out-of-pocket maximum, it can be as high as $7,550 in 2022 ($8,300 in 2023).

2. Regular Dental Care

Although some dental services provided as part of a hospital stay are covered by Medicare Part A, basic dental care such as cleanings, X-rays, and fillings are not. You must purchase a separate dental policy if you want coverage.

You might be able to get some coverage if you buy a Medicare Advantage plan that includes dental benefits. "However, those benefits may be limited, or Medicare Advantage plans may require you to pay an additional fee for those benefits," says Lina Walker, vice president of health security for AARP's Public Policy Institute.

3. Eye Examinations

Medicare does not cover eye exams for glasses or contacts, nor does it cover the actual glasses or contacts. If you have cataract surgery, Medicare Part B will cover one pair of glasses or contacts. (You'll pay 20% of costs after the Part B deductible of $233 in 2022 ($226 in 2023).)

You might be able to get some coverage if you buy a Medicare Advantage plan that includes vision coverage.

4. Aids To Hearing

Hearing aids and hearing aid exams are also not covered by Medicare. While the Build Back Better Act includes language to add hearing aid coverage to Medicare, the bill has yet to be passed by Congress. If your doctor believes you need diagnostic hearing tests, Medicare will pay for them.

You might be able to get some coverage if you buy a Medicare Advantage plan that includes hearing aids.

5. Prescription Medications

Prescription drug coverage is not available under Original Medicare Parts A and B. If you need prescription drug coverage, you must purchase a Medicare Part D plan from a private insurance company or enroll in a Medicare Advantage plan that includes it.

If you choose not to enroll in Medicare drug coverage and do not have other creditable drug coverage, you will face a late enrollment penalty if you decide to enroll later. This penalty will apply as long as you have Medicare drug coverage, so it's important to get and keep qualified coverage once you're eligible.

6. Long-Term Care Services

According to the Department of Health and Human Services, a person turning 65 today has a 7-in-10 chance of needing long-term care at some point in the future, and it can be costly. However, Medicare does not cover long-term care if it is the only care you require.

"This is an area where there may be some confusion," Walker says, "because people have heard that Medicare covers nursing services." If your doctor recommends it after a qualifying three-day inpatient hospital stay, Medicare will cover skilled nursing facility care. In these cases, Medicare pays for the first 100 days of care, plus a daily coinsurance charge. After that, you are solely responsible for all expenses.

Medicare Advantage plans may provide some limited additional benefits. "Some Medicare Advantage plans provide in-home care, but it's pretty limited coverage at this point, and only a few plans do," Jacobson says.

7.International Health Care

Except, in very specific circumstances, Medicare does not cover health care or supplies if you are outside of the United States and certain U.S. territories. (For example, if you have a medical emergency while traveling between Alaska and another state and a Canadian hospital is closer than a U.S. hospital, Medicare may cover your care.) Otherwise, you'll need to find supplemental travel insurance or buy insurance in the country where you live.

This is crucial if you intend to relocate outside of the country. If you decide to return to the United States and re-enroll in Medicare, you may be subject to Part B penalties. "It's critical that they find out what the implications are for them if they give up Medicare before they move," Walker says.