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Surprising Things Senior Health Insurance Doesn’t Cover

Posted by Alyssa Ball on August 7, 2018

Senior discussing health insurance with a doctor

Most seniors may think that their Medicare A or B plus covers every Medicare-approved service or treatment. Unfortunately, some of the most expensive medical necessities are not covered. Read the following list of things not covered by Medicare to make sure you or a loved one isn't left paying out of pocket. 

Glasses & Other Vision Care

Vision care is typically not covered by insurance. If you need glasses, only the eye exam is covered by Medicare. Testing for the corrective lenses you will need and your glasses themselves are not covered by insurance. However, the first pair of glasses after cataract surgery is covered. In this case, only basic lenses and an inexpensive frame are covered. Medicare will not pay for bifocals or transition lenses.

Treatment for glaucoma, cataracts, and other eye diseases are covered, but required medication is not unless you have a prescription drug plan. LASIK surgery to correct vision and contact lenses are also not covered.

Dental Care

Dental care is not included unless you have an emergency condition or require a complicated procedure. Dentures, which can cost from $1,000 to $5,000 for a complete set, are not included. Tooth implants—generally about $4,000 per tooth—are not included. Additionally, routine cleanings, X-rays, fillings, and dentures are not covered under Medicare. 

Hearing Aids

Hearing aids and audiologist services are not included in most insurance policies, and they can cost thousands of dollars. Approximately 1 in 3 people over 70 have hearing loss, and nearly half of those older than 75 have difficulty hearing. 

Incorrect Hospital Admissions

Hospital admissions must be correctly coded. If you are admitted to a hospital for observation, Medicare will not pay for your hospital stay. Make sure to be admitted for treatment, not observation. Rehabilitation hospital or center stays are not covered unless you have been an inpatient at a regular hospital for at least 3 days.   

Health Care Outside the US

In general, health care you receive while traveling outside the US is not covered. You can get your treatment covered in the District of Columbia, Puerto Rico, the US Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. In very rare cases, Medicare will pay for inpatient hospital, doctor, ambulance services, or dialysis in foreign countries.  

Some low-income people can qualify for programs that reduce their Medicare-related costs. There's extra help for prescription drug coverage, and some state-run savings programs can help with copays, coinsurance, deductibles and premiums. For those who don't qualify, paying out of pocket or buying additional insurance are their options. If you decide on an Advantage Plan, there's a good chance dental and vision will be included. However, it will likely be limited. 

Medicare and other insurance options for seniors can be confusing, so hopefully we have been able to clear some questions up.

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Alyssa Ball Blog Author

Topics: Medicare

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