What Does Medicare Not Cover?

Ken Haglind

December 13, 2022

Purpose of HealthCare

Regardless of whether you are a new Medicare patient or are still in the plan, it is important to know what will not be covered. Some common services that will not be paid for include prescription drugs, dental work, and ambulance services.

Preventive services

Using Medicare to pay for preventive services can be a confusing topic. There are a number of different rules that apply to preventive care coverage. Some require that a certain provider or condition be present to be covered. Others may be subject to deductibles, copays, or facility fees.

When a patient receives a preventive service, he or she will need to see a provider who accepts Medicare. When a provider agrees to accept Medicare, they agree to accept the amount of money Medicare has approved for a service as full payment. If the provider does not accept the Medicare payment, he or she is responsible for payment.

Prescription drugs

Depending on which drug plan you choose, you may need to pay a certain copayment or out-of-pocket cost for a prescription. You’ll find a wide variety of plans that offer different benefits and prices.

You should know that Medicare does not automatically cover prescription drugs. However, it can help you pay for them. Some states also offer programs to help people pay for prescription drug costs.

Most older adults get prescription drug coverage through a Medicare Part D plan. These plans work with drug manufacturers to negotiate prices for the drugs. Some pharmaceutical companies have a program that will reduce the price of some brand-name drugs if the patient is enrolled in the program.

Home health care

Depending on your situation, Medicare may or may not cover home health care. Oftentimes, you will need to purchase supplemental insurance to cover services that are not covered. If you’re unsure about coverage, make a pre-claim review request. The request will help you determine whether you’re covered for home health care and what you can expect to pay.

To be eligible for Medicare coverage, you must have a condition that requires skilled nursing or rehabilitation therapy. To qualify, you must also be certified as homebound by a medical professional. The certification is based on a documented face-to-face encounter with a medical professional within 90 days before you start home health care.

Ambulance services

Getting an ambulance to your home or doctor’s office can be an expensive proposition without insurance. In some cases, Medicare will cover a portion of the cost, but in others, you’ll be responsible for the entire bill.

In general, Medicare Part B covers 80% of the cost of transportation to the nearest medical facility. This coverage may include ground transport, helicopter, and airplane services.

Medicare also pays for non-emergency ambulances when they’re required by a physician’s order. The medically necessary part of this is the same as other Part B care.

There are a few things you can do to avoid an unexpected bill. First, request prior authorization from your insurer. Second, check with your healthcare provider to see if your coverage includes any nonemergency transportation benefits. You can also opt to forego the service.

Dental work

Despite Medicare’s extensive coverage of outpatient medical services and hospitalization, dental services are not covered by the federal health care program. Rather, you pay for these expenses out of pocket. Although Medicare will cover some dental procedures as part of other covered services, such as surgery or the treatment of chronic illnesses, it will not pay for routine dental care such as teeth cleanings or fillings.

Several factors affect the cost of dental benefits for Medicare beneficiaries. The scope of dental benefits offered by the various plans varies. Some are more comprehensive than others, which could lead to high out-of-pocket costs for people with serious dental needs.

Routine vision and hearing care

Despite recent proposals to expand Medicare coverage of dental services, the majority of hearing and vision coverage remains underwritten by private insurers, Medicaid, or stand-alone plans. However, this does not mean that vision and hearing care will be free. In fact, 65 percent of the average hearing and dental service costs are out of pocket. This makes it difficult for many people to obtain the care they need.

In 2018, fewer Medicare beneficiaries used routine hearing services than routine vision services. Those with Medicare spent an average of $1,302 on hearing and dental services, while those without Medicare spent an average of $242. This is because insurance covers a smaller percentage of the cost of hearing than of vision.