1. Long-Term Care

One of the most significant gaps in Medicare coverage is long-term care. While Part A of original Medicare does provide limited coverage for skilled nursing facility care following a hospital stay, it has specific conditions and time limitations (100 days).  It does not cover custodial care, which includes assistance with daily activities such as bathing, dressing, and eating.  For long-term care needs, it’s important to consider alternative options such as long-term care insurance or a Medicare supplement plan to help alleviate some of the costs associated with the gap in coverage .

2. Dental Care

Routine dental care, including check-ups, cleanings, fillings, dentures, and most dental procedures, are not covered by Medicare. While there are a few exceptions, such as dental services required prior to a covered medical procedure, most dental expenses will be your responsibility. If dental coverage is important to you, you may want to explore private dental insurance plans or dental discount programs that cover dental services.

3. Vision and Hearing

Original Medicare generally does not cover routine vision and hearing care, such as eye exams, eyeglasses, contact lenses, hearing aids, or routine hearing tests. However, there may be some exceptions for medically necessary eye exams or hearing tests. To cover these expenses, you may consider purchasing stand alone vision insurance.

4. Prescription Drugs (Part D)

While Medicare does cover prescription drugs, it requires a separate plan known as Medicare Part D. Part D plans are offered through private insurance companies and can provide coverage for a wide range of prescription medications. It’s important to carefully review and select a Part D plan that best meets your specific medication needs to avoid potentially high out-of-pocket costs.

5. Cosmetic Procedures

Medicare does not cover cosmetic procedures or surgeries performed solely for cosmetic reasons. Examples of such procedures include facelifts, breast augmentation, or liposuction. However, if a procedure is deemed medically necessary for functional or reconstructive purposes, Medicare may provide coverage. It’s essential to consult with your healthcare provider and insurance company to understand what is covered in specific cases.

6. Routine Foot Care

Medicare does not typically cover routine foot care, such as nail trimming, callus removal, or treatment of corns and bunions. However, there are exceptions for certain foot conditions that are medically necessary, such as diabetic foot care or foot-related complications for individuals with diabetes. To address routine foot care needs, consider private insurance options or alternative payment methods.

7. Medical Services Outside the United States

Medicare generally does not cover medical services received outside the United States. In rare cases, such as emergency care in Canada or Mexico, Medicare may provide limited coverage. For Medicare coverage while traveling you may want to consider a Medicare Supplement (Medigap)  or Medicare Advantage plan. Some Medigap plans may offer 60-day emergency coverage with 80% costs covered after a deductible and lifetime limit. Some Medicare Advantage plans may also cover emergencies abroad.

Understanding what Medicare does and does not cover is crucial for effectively managing your healthcare expenses. While Medicare provides essential coverage for many healthcare services, it’s important to be aware of the gaps in coverage. Considering supplemental insurance plans, such as Medigap or Medicare Advantage, can help fill these gaps and