The categories of medical treatment and services listed below are not covered by Medicare. However, the non-covered services listed below do not necessarily apply to HMO or other Medicare Advantage plan coverage. Many Medicare Advantage plans include some coverage for these medical services even though Medicare itself does not cover them. (To see a list of the services that Medicare Part B does cover, see our article on Medicare Part B coverage.)
Medicare will not pay for medical care that it does not consider medically necessary. This includes some elective and most cosmetic surgery, plus virtually all alternative forms of medical care such as acupuncture, acupressure, and homeopathy—with the one exception of the limited use of chiropractors.
Medicare does not cover most vaccinations and immunizations— such as those taken before travel abroad. There is one exception for emergencies in which, for example, vaccinations or immunizations are required because of the risk of infection or because of exposure to a communicable disease. Other exceptions are made for the pneumonia vaccination, if prescribed by a doctor, and for a flu shot.
Part B medical insurance covers only drugs that cannot be self-administered and that you receive as an outpatient at a hospital, a clinic, or at the doctor's office.
Medicare Part A covers drugs administered while you are in the hospital or in a skilled nursing facility, and coverage for all other prescription drugs falls under Medicare Part D, which you must enroll in and pay for separately from Parts A and B. (See our article on Part D prescription drug coverage for more information.)
Medicare Part B does not cover any of the cost of nonprescription ("over-the-counter") medicines, vitamins, or supplements, regardless of whether they provide help with a medical condition, even if they have been recommended by a doctor.
Medicare medical insurance does not cover routine eye or hearing examinations. Neither does it cover hearing aids, eyeglasses, or contact lenses, except for lenses required following cataract surgery. However, if your eyes or ears are affected by an illness or injury other than simple loss of strength, the examination and treatment by an ophthalmologist—an eye doctor who is an M.D.—or other physician is covered.
Medicare does not cover work performed by a dentist or oral surgeon, unless the same work would be covered if performed by a physician. In other words, if the treatment is considered medical rather than dental, Medicare may cover it. Generally, Medicare will not cover treatment unless the problem is unrelated to normal tooth decay or gum disease, and involves either the blood vessels, nerves, or interior of the mouth, or the bones of the mouth or jaw.
While Medicare Part B covers some home health care (see our article on Medicare coverage of home health care), that care is always relatively short-term, limited to a period of recovery from an acute illness, injury, or condition. Medicare does not provide the kind of long-term care, either at home or in a facility, that many older people need because of frailty or other inability to perform, without help, the activities of daily life. (See our article on Medicaid's coverage of nursing home and assisted living facilities.)
When you look at the list of what Medicare medical insurance does not cover, it's easy to understand why people with Medicare still wind up personally responsible for an average of half of their medical bills.
Part B Medicare medical insurance is intended to pay for only a portion of doctor bills, outpatient hospital and clinic charges, laboratory work, some home health care, physical and speech therapy, and a very few drugs and medical supplies.
Private Medicare supplement insurance—called medigap insurance—may help you make up the difference. Alternatively, many people fill in the gaps in Medicare by joining a Medicare Advantage health plan (called Medicare Part C). A Medicare Advantage plan often comes in the form of a managed care plan and combines basic Medicare-level coverage with supplemental benefits. If you cannot afford private supplement insurance, you may be eligible for Medicaid—a public program for people with low income and few assets.
For more information, see our articles on medigap insurance, Medicaid, and Medicare Advantage plans.
by: Attorney Joseph Matthews
Need a lawyer? Start here.