Medicare typically does not cover a range of services that are considered non-essential or fall outside the scope of medically necessary treatments. The 6 things Medicare generally doesn't cover are: eye exams for prescription eyeglasses, long-term care, cosmetic surgery, massage therapy, routine physical exams, and hearing aids and exams for fitting them.
Services Not Covered by Medicare
Understanding what Medicare does not cover is as crucial as knowing what it does. While Medicare provides extensive health insurance coverage for many medical services, certain items and services are specifically excluded. This ensures beneficiaries are aware of potential out-of-pocket costs and can plan accordingly for their healthcare needs.
Here are the 6 common items and services not covered by Original Medicare:
| Category | Description |
|---|---|
| Eye Exams (for eyeglasses) | Routine eye exams for the purpose of prescribing eyeglasses or contact lenses are generally not covered. |
| Long-Term Care | This includes custodial care, such as help with daily activities (dressing, bathing) over a long period. |
| Cosmetic Surgery | Procedures performed solely to improve appearance, not to restore body function or correct a deformity. |
| Massage Therapy | Services provided by a massage therapist are typically not covered. |
| Routine Physical Exams | Standard annual physical exams are not covered, though Medicare does cover "Welcome to Medicare" and annual "Wellness" visits. |
| Hearing Aids and Exams | Hearing aids and exams for fitting them are not covered by Original Medicare. |
Detailed Overview of Exclusions
It's important to note the specific nature of these exclusions to avoid confusion.
- Eye Exams (for Prescription Eyeglasses): While Medicare generally doesn't cover routine eye exams for glasses or contacts, it does cover medically necessary eye care, such as exams for glaucoma or cataracts.
- Long-Term Care: This refers to non-skilled personal care. Medicare Parts A and B may cover skilled nursing facility care for a limited period if it's medically necessary after a hospital stay, but not ongoing custodial care at home or in nursing homes.
- Cosmetic Surgery: If cosmetic surgery is performed to correct an accidental injury, improve the function of a malformed body part, or after an illness like breast cancer (reconstructive surgery), it may be covered. However, purely aesthetic procedures are not.
- Massage Therapy: This is typically considered an alternative or complementary therapy and is not covered. However, physical therapy ordered by a doctor for a medical condition is covered.
- Routine Physical Exams: Original Medicare does not cover a traditional annual "physical exam." Instead, it covers a "Welcome to Medicare" preventive visit within the first 12 months of enrollment and annual "Wellness" visits, which focus on preventing illness and managing chronic conditions, rather than a head-to-toe physical.
- Hearing Aids and Exams for Fitting Them: Original Medicare does not cover hearing aids or routine hearing exams required to get them. This can be a significant out-of-pocket expense for many individuals.
For more detailed information on what Medicare covers and what it doesn't, you can visit the official Medicare website: What's Not Covered? - Medicare.
