What Medicare covers
What does Medicare not cover?
For a service Original Medicare leaves out, type the price you were quoted: the estimator shows that it is all yours, and what an Advantage plan allowance would take off.
What this service costs you
You pay · Not covered by Original Medicare
$0
Original Medicare does not pay for it: you pay the full price. Medigap does not cover it either.
How this is calculatedOriginal Medicare, Parts A and B, does not pay for eye exams for prescription glasses, non-medical long-term care, cosmetic surgery, massage therapy, routine physical exams, hearing aids and the exams for fitting them, concierge care, covered services from a provider who has opted out of Medicare (except in an emergency or urgent need), and most dental care such as cleanings, fillings, extractions and dentures. For these you pay the whole bill, and a Medigap policy pays nothing either, because Medigap only fills gaps in services Medicare covers. Several exclusions have a covered neighbor: a diagnostic hearing test ordered by a doctor is covered, leaving you $7 at national rates with the deductible met, while the hearing aid itself is not; one pair of glasses is covered after cataract surgery; dental care closely tied to a heart valve replacement, an organ transplant, cancer treatment or dialysis can be paid. A Medicare Advantage plan, a Medicare Cost Plan or a PACE plan may add vision, hearing and dental benefits.
A year of what Medicare leaves out
You pay
$0
| Billed | $0 |
| Original Medicare pays | $0 |
| Allowances | $0 |
Costs computed by Radif Partners · Editorial policy · How the costs are calculated
The list, as medicare.gov gives it
- Eye exams for prescription eyeglasses, also called refractions.
- Non-medical long-term care.
- Cosmetic surgery and massage therapy.
- Routine physical exams.
- Hearing aids and the exams for fitting them.
- Concierge care, also called retainer-based, boutique or direct care.
- Services from a provider who opted out of Medicare, except in an emergency or urgent need.
- Most dental care: routine cleanings, fillings, tooth extractions, dentures.
Each item is on the medicare.gov page of services Parts A and B do not cover. The page adds that you pay for them yourself unless you have other health coverage or a plan that covers them.
The covered service next to each exclusion
An exclusion is rarely as wide as it sounds. In most cases a medical version of the same care is covered, at 20% after the deductible, while the routine version is not.
| Not covered | Covered instead | You pay for the covered one |
|---|---|---|
| Hearing aids and fitting exams | Diagnostic hearing test ordered by a doctor | $7 |
| Eye exam for glasses | Medical eye exam (diabetes, glaucoma) | $25 |
| Ordinary glasses | Glasses after cataract surgery | $39 |
| Routine foot care | Podiatrist visit for a foot problem | $19 |
| Massage therapy | Physical therapy session | $17 |
| Acupuncture for other pain | Acupuncture for chronic low back pain | $10 |
Dental care: four exceptions
Original Medicare may pay for dental services closely related to certain covered care: before or with a heart valve repair or replacement, an organ transplant, cancer-related treatment, and dialysis for end-stage renal disease. Outside those cases, cleanings, fillings, extractions and dentures are yours to pay. The dental page prices both sides.
Who can pay what Medicare does not
A Medicare Advantage plan, a Medicare Cost Plan or a Program of All-inclusive Care for the Elderly (PACE) may cover extra benefits such as certain vision, hearing and dental services. Other health coverage you have may also pay part of these costs. If your plan gives you an allowance for glasses, hearing aids or dental work, the calculator below adds up a year of excluded expenses and subtracts what those allowances cover.
A year of what Medicare leaves out
You pay
$0
| Billed | $0 |
| Original Medicare pays | $0 |
| Allowances | $0 |
Before you get a service
Ask the doctor or supplier how much the test, item or service will cost and why it is recommended. Doctors may propose services Medicare does not cover, or offer them more often than Medicare pays. What you owe depends on your other insurance, on how much the doctor charges, on whether the doctor accepts assignment, on the type of facility and on where you get the service. For a covered service, the estimator gives the Medicare-approved amount; for an excluded one, only the price quoted counts.