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What Medicare Does And Does Not Cover

Christian Worstell

by Christian Worstell | Published April 22, 2021 | Reviewed by John Krahnert

Medicare Part A and Part B (Original Medicare) will cover a lot of your health care costs, but it won't cover everything. Typically, you will be responsible for paying for most services that aren’t considered necessary for your health.

If the service you need is covered by Medicare, it’s likely you will still have to pay something for it in the form of a deductible, coinsurance or copayment.

You can consider applying for a Medicare Supplement (Medigap) plan that can help cover these out-of-pocket Medicare costs, which can add up quickly.

Doctor smiles as he speaks with his patientMedicare covers a lot of services, but it doesn't cover everything.

What Medical Services Are Not Covered by Original Medicare?

Original Medicare covers costs associated with doctors and hospital services that it deems medically necessary. This means that any kind of cosmetic or alternative health treatments you may be interested in may not be covered.

Dental, vision and hearing services are also not covered by Original Medicare.

The following is a list of some of services not included in Medicare coverage: 

  • Long-term (custodial) care
    Help with daily tasks such as bathing, dressing and using the bathroom is not covered under Original Medicare, unless you are receiving skilled care in a nursing facility.

  • Most types of dental care
    Part A will pay for emergency dental procedures as well as some dental services while you are in the hospital. It does not cover dentures.

  • Most types of vision care
    Except when necessary after cataract surgery, Original Medicare does not cover routine eye exams or fittings for glasses or contacts.

  • Hearing aids
    You pay 100% for hearing aids and hearing aids exams on Original Medicare.

  • Cosmetic surgery
    Medicare does not cover cosmetic surgery unless it would improve the function of a malformed body part or is required due to an accidental injury. If you have had a mastectomy because of breast cancer, Medicare will cover breast prostheses.

  • Alternative medicine
    You may have to pay out of pocket if you want something like acupuncture. Experimental treatments and procedures are also not covered.  

  • Non-medical services
    You are responsible for all canceled appointments, private hospital rooms and any other non-medical services.

  • Routine foot care
    Routine foot care and some other types of preventive care are not covered.

  • Care in foreign countries
    With few exceptions, you will pay the entire cost of medical care received outside of the U.S.

If you are looking to find out if a specific test, item or service is covered by Original Medicare, you can use the search tool found on Medicare.gov.

Does Medicare Cover Prescription Drugs?

Original Medicare alone does not cover the cost of prescription drugs.

If you want Medicare prescription drug coverage, there are two options you may be able to consider:

Part D plans and Medicare Advantage plans are sold by private insurance companies. Plan availability and the drugs they cover may vary.

You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

How Much Does Medicare Cost?

The kind of care you need may be covered by Medicare, but that doesn’t mean it will be covered at 100%. Original Medicare often comes with deductibles, copayments and coinsurance.

  • Typically, for services covered under Part A (hospital services), you will have to pay a $1,484 deductible for each benefit period in 2021, as well as possible coinsurance if you are in the hospital for more than 60 days of the benefit period.

  • For services covered under Part B (medical services), you will have to meet a $203 deductible for the year in 2021.

    Once the deductible is met, you then will typically have to pay 20% of the Medicare-approved amount for all doctor’s services, outpatient therapy and durable medical equipment.

Medigap Plans Can Help Cover Your Medicare Costs

Keeping up with exactly how much Original Medicare will cover and not cover can be stressful, especially if you’re worrying about keeping medical costs down.

Medigap (also known as Medicare Supplement Insurance) plans can help fill in the coverage gaps left behind by Original Medicare and help you pay less out of pocket for medical costs.

Some Medigap plans even offer coverage for services not covered by Original Medicare at all, such as emergency health care while traveling abroad.

There are 10 standardized Medigap plans available in most states. You can use the 2019 Medigap plans comparison chart below to compare the benefits of each type of plan.

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Medicare Supplement Benefits

Part A coinsurance and hospital coverage

Part B coinsurance or copayment

Part A hospice care coinsurance or copayment

First 3 pints of blood

Skilled nursing facility coinsurance

Part A deductible

Part B deductible

Part B excess charges

Foreign travel emergency

Medicare Supplement Benefits A B C* D F1* G1 K2 L3 M N4
Part A coinsurance and hospital coverage
Part B coinsurance or copayment 50% 75%
Part A hospice care coinsurance or copayment 50% 75%
First 3 pints of blood 50% 75%
Skilled nursing facility coinsurance 50% 75%
Part A deductible 50% 75% 50%
Part B deductible
Part B excess charges
Foreign travel emergency 80% 80% 80% 80% 80% 80%

* Plan F and Plan C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible for Medicare before 2020, you may still be able to enroll in Plan F or Plan C as long as they are available in your area.

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1 Plans F and G offer high-deductible plans that each have an annual deductible of $2,370 in 2021. Once the annual deductible is met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries who became eligible for Medicare on or after January 1, 2020.

2 Plan K has an out-of-pocket yearly limit of $6,220 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

3 Plan L has an out-of-pocket yearly limit of $3,110 in 2021. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.

4 Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to $50 copayment for emergency room visits that don’t result in an inpatient admission.

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Learn more about common procedures that medicare covers.

Compare 2021 Medigap Plans Where You Live

A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.

 

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Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

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