8 Surprising Things Original Medicare Doesn't Cover

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There's a lot to think about when you're choosing a Medicare plan. And it's important your plan provides access to the care and benefits you need, to take care of the whole you. Did you know there are four parts to Medicare — A, B, C, and D? Original Medicare includes Part A and Part B, which includes a lot, but not everything. That's where Medicare Part C (Medicare Advantage plans) or Medicare Supplement plans (also known as Medigap) come in.


Like Original Medicare, Medicare Advantage plans combine Parts A and B. Some Medicare Advantage plans also offer prescription drug coverage (Part D). Unlike Original Medicare, Medicare Advantage plans might also include other benefits at no added cost, like hearing aids or eye care, fitness memberships, wellness services, or a nurse phone line.

Before you shop for a Medicare plan, do your research to find out what's covered and what's not. It can help you save time and money. Here's a closer look at what Original Medicare might not cover:

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1. Long-term custodial (non-medical) care

Long-term care, which includes nursing home care, home health aides, and more, is one of the largest potential expenses in retirement. On average, the cost of a private nursing home is $97,000 a year, while an assisted living facility costs $45,000, according to a 2017 Genworth study. Original Medicare doesn't cover long-term non-medical care (often called custodial care). Long-term custodial care isn't covered by most health insurance plans, but may be covered under Medicaid. You can also choose to buy private long-term care insurance.

2. Prescription drugs

Medicare Part B (medical insurance) only covers some prescription medicines. Medicines that aren't covered under Part B may be covered under Medicare Part D, which can be purchased separately by a private insurer. Medicare Advantage plans, which include Part A and Part B, may also include Part D. Before you make any changes, check your plan's formulary — the list of medicines the plan covers — to see if your medicines are covered.

3. Deductibles, copays and coinsurance

Medicare Part A covers things like hospital stays, hospice care, and home health care. Part B covers medically necessary doctors' services, outpatient care, durable medical equipment, and more. You're still responsible for deductibles and copayments or coinsurance.

4. Some dental care

Original Medicare doesn't cover routine dental visits, teeth cleanings, fillings, dentures, or most tooth extractions. Some Medicare Advantage plans offer dental coverage, or you can buy dental insurance separately.

5. Hearing aids

Original Medicare doesn't cover hearing exams, hearing aids, or exams for fitting hearing aids. Check with your health insurer, as some Medicare Advantage plans cover hearing aids and fitting exams, and also provide discount programs and savings on hearing aids.

6. Routine vision care

Original Medicare covers annual eye exams if you have diabetes or another chronic condition, or if you require eyeglasses after having certain kinds of cataract surgery. However, many routine eye exams or new eyeglasses aren't covered. Check with your plan, or look into a Medicare Advantage plan if you need more comprehensive vision benefits.

7. Medical expenses while traveling overseas

Generally, Original Medicare doesn't cover the care you get while traveling outside the U.S., except in very limited circumstances. Some Medicare Advantage plans cover emergency care abroad. Or you can look into Medicare Supplement insurance plans (also known as medigap) for coverage abroad.

8. Acupuncture

Under Original Medicare, you'll pay 100% of the costs for acupuncture services. The good news is that some Medicare Advantage plans cover alternative therapies such as acupuncture. It depends on where you live and the plan you're enrolled in.

Looking for more information?

Visit Health's Senior Health and Wellness Resource Center,
your destination for 2019 Medicare information.

You have options

Medicare can be overwhelming, but you have options. Whether you're looking at Original Medicare, Medicare Advantage or Medicare Supplement plans, it's important you take the time to research to ensure you're getting the health care and coverage you need.

Amy Capomaccio is a health care writer at Aetna with experience in senior wellness, Medicare, Medicaid, and commercial health care. When she's not practicing new mindfulness techniques, Amy is spending time outdoors and traveling. Amy hails from Wakefield, MA and has a degree in Advertising and Public Relations from the University of Tampa.

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