As a senior eligible for Medicare, you’re likely excited about having help meeting your healthcare needs. With the costs of care increasing every day, Medicare offers peace of mind and security. But Original Medicare (Part A and Part B) doesn’t cover everything, and seniors often need to supplement coverage with additional insurance. While there are plenty of resources for learning about Part A and Part B coverage, knowing what is not covered will help you make an informed decision about whether or not additional insurance is the right choice for you. Here are the basics: what is not covered by Medicare Part A and Part B.

Part A Hospital Insurance

Medicare Part A provides benefits for recipients in need of inpatient care in a hospital, skilled nursing facility, and in some limited cases, at home. Benefits typically include costs related to inpatient care, like room and board, medications, and bedside nursing. While Part A coverage includes many services and supplies, it does not cover costs associated with a private room, personal items, television, or charges for telephone use while in the hospital. Part A also does not cover the cost of blood until the third pint. Home health care that is medically necessary is covered in part, as is physical, occupational, and speech therapy, and most medical equipment ordered by your doctor. 

Not Covered By Medicare Part A

• Private room
• Personal care items (shampoos, toothpaste, etc.)
• Television, phone charges
• First three pints of blood
• 24-hour home care
• Meals and homemaker services not related to treatment
• In-home personal care (bathing, dressing, etc.) 

Part B Medical Insurance

Medicare Part B provides coverage for services and supplies that are required to treat a health condition. This typically includes outpatient care services, ambulance services, durable medical equipment, lab tests, x-rays, and some home health rehabilitative services, such as physical therapy. However, Medicare Part B will not pay for costs associated with alternative medicine, cosmetic surgery, vision, hearing, dental, prescription and nonprescription medication, long-term care or medical care received while overseas.

Not covered by Medicare Part B

• Elective and cosmetic surgery
• Alternative medicine – acupuncture, homeopathy
• Vaccinations and immunizations
• Prescription and nonprescription drugs
• General dental work, dentures
• Long term care
• Hearing aids and exams for fitting
• Eye examinations for prescribing glasses

Remember, even if Original Medicare covers a specific type of service, generally, it does not pay 100 percent of the cost. Many seniors supplement Medicare Part A and Part B with Medicare supplement insurance or opt to receive their coverage through a Medicare Advantage plan, which offers all the coverage provided by Part A and Part B as well as additional benefits seniors need and deserve.

References:

https://www.medicare.gov/what-medicare-covers/not-covered/item-and-services-not-covered-by-part-a-and-b.html

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Items-and-Services-Not-Covered-Under-Medicare-Booklet-ICN906765.pdf

MUC20-2016-BCBS