What Original Medicare Doesn’t Cover
When composing this article, I didn’t know which way to go. Such as writing an article about items covered or what original Medicare doesn’t cover. Medicare’s website lists the majority of covered services. To see them, go to https://www.medicare.gov/coverage/is-your-test-item-or-service-covered. There you can browse through over 100 topics.
Many services and tests that you might think should be covered, are not or come with restrictions. Below is a list of items that Medicare generally does not cover. To clarify, original Medicare is different from a Medicare Advantage or Medicare Supplement plan.
- Acupuncture. It is not medically necessary.
- Cosmetic Surgery. It is not medically necessary unless it is because you were in an accidental injury. It could also be to repair the function of a malformed appendage.
- Care outside of the US, with some exceptions. This could be if a foreign facility is closer to your emergency or you are on a boat within a certain distance of the US.
- Insulin (unless the use of an insulin pump is medically necessary ), Insulin pens, Syringes, Needles, Alcohol swabs, Gauze.
- Long Term Care as it is mostly service and support for personal care, such as what you would receive in a Nursing Home.
- Outpatient prescription drugs. A Part D plan or Medicare Advantage Plan can cover these.
In addition, there are some more routine medical services that are also not covered.
- Routine hearing exams, hearing aids and exams to fit hearing aids, unless medically necessary due to hearing loss from an injury or illness.
- Basic foot care including orthopedic shoes, unless medically necessary because of certain diseases such as cancer, M.S., diabetes or complications of it.
- Routine Eye Exams, eyeglasses, and contacts. Although, medically necessary eye care such as for cataracts usually is an exception.
- Screening test and labs, if routine. Although once again, if it is medically necessary then it may be an exception.
- Some common vaccines such as those for Shingles, TDAP (Tetanus, Diphtheria & Pertussis) and Meningococcal.
There are few hard & fast rules with uncovered services and tests. Medically necessary means reasonably necessary in order to diagnose then treat an injury to or improve the functioning of the body. Please give our office a call if you have more questions about what original Medicare doesn’t cover. As your health insurance broker, we can give a no-cost consultation for your health insurance needs.
