The good news: Once you hit 65, Medicare covers many medical issues entirely, and others with just a few pre-requisites.
The not-as-good news: Some equipment, treatments, and conditions—like those in the following seven categories—aren’t covered at all.
Read on to discover what’s not paid for, as well as the exceptions to each. And remember: Always check with an insurance representative and an official resource before visiting your doctor.
1. NOT COVERED: Routine foot care
You’ll have to cough up your own cash for hygiene services, flat feet, shoe inserts, and routine procedures, like removing calluses and corns.
EXCEPTIONS: When treatment is medically essential or related to other conditions, like diabetes and vascular diseases, you’ll be covered. Medicare will also pay for plantar warts and certain toenail fungus.
2. NOT COVERED: Dental
From exams to fillings to oral surgery, you’ll pay for almost all dental services yourself.
EXCEPTIONS: There is a pair of comparatively rare exceptions here:
- Facial x-rays connected to a broken bone or fractured jaw
- Tooth extractions to allow for radiation of a tumor
3. NOT COVERED: Services procured outside the United States
Most treatments and services, including dialysis, drugs, and medical tourism (in which you travel abroad for, say, a hip replacement) are not covered outside the country. In this case, the U.S. includes Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, the North Mariana Islands, and certain cruise ship destinations.
EXCEPTIONS: Medical emergencies are largely taken care of, as is this somewhat uncommon circumstance: “You live in the U.S. and the foreign hospital is closer to your home than the nearest U.S. hospital that can treat your medical condition, regardless of whether it’s an emergency.”
4. NOT COVERED: Services provided by family members
If your father-in-law is a doctor and treats you, he will not be reimbursed for his services. This also extends to anyone residing in your home, excluding boarders.
EXCEPTIONS: The federal government is very specific about who qualifies as a family member, so it always pays to check. If your second cousin is a cardiologist, you might be in luck.
5. NOT COVERED: Your routine hearing and vision needs
You’re on your own for exams and everyday apparatuses like glasses, contacts, and hearing aids.
EXCEPTIONS: Auditory brainstem and cochlear implants—which differ from hearing aids—are covered. Eye diseases like glaucoma and cataracts are covered, as well, as are vision difficulties connected to other illnesses, such as diabetic retinopathy.
6. NOT COVERED: Long-term custodial care
If the care is purely personal—“activities of daily living” like bathing and feeding—you’re out of luck.
EXCEPTIONS: If you or a loved one require medical attention at home, Medicare will help pay some expenses. Hospice care, which aims to make a patient as comfortable as possible in the event of a terminal illness, is also covered at a short-term facility, but not in the home.
7. NOT COVERED: Cosmetic surgery
From facelifts to Botox, your nips, tucks, and injections come out of pocket.
EXCEPTIONS: Plastic surgery is covered for many malformed body parts, burns, and facial scars stemming from car accidents. Breast prostheses after a mastectomy are generally covered, too, as are the removal of implants that pose a danger to your health.
8. NOT COVERED: Alternative healing treatments
Medicare benefits do not extend to things like massage therapy, transcendental meditation, acupuncture, and more, since they’re often designated as “Not Medically Reasonable and Necessary.”
EXCEPTIONS: There are very few allowances here, if any.
For clarification or a further explanation of any of these categories—or to check and see if your own ailment is covered—try the following resources:
- Items and Services That Are Not Covered Under the Medicare Program at cms.gov
- Is your test, item, or service covered? at Medicare.gov
If this seems like a lot, don’t panic. The services and treatments not covered by Medicare can be financed through Medicare Advantage and Medigap policies. Go to Medicare.gov, the official Medicare site of the U.S. government, to learn more.
Also from Grandparents.com:
Your Common Medicare Questions Answered
5 Questions Everyone Should Ask Before Choosing A Medicare Plan
6 Questions To Ask Before An Aging Parent Moves In
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