10 Surprising Things Medicare Doesn’t Cover

While original Medicare covers ophthalmologic expenses such as cataract surgery, it doesn’t pay for routine eye exams, glasses or contact lenses. Some private Medicare Advantage plans cover routine vision care and glasses.​​

If you’ve been diagnosed with diabetes, both original Medicare and Medicare Advantage will cover an eye exam each year. In addition to checking your vision, a specialist will look for damage that can lead to permanent vision loss, including diabetic retinopathy, which affects blood vessels inside your eye; cataracts clouding the lens of your eye; and glaucoma, which damages the optic nerve if pressure from fluid inside your eye gets too high.

The fix. For some people, buying a vision insurance policy for a few hundred dollars a year to defray the cost of glasses or contact lenses makes sense. Even though standard Medigap plans, the supplemental insurance available from private insurers to augment original Medicare coverage, don’t cover vision, some companies let you buy extra benefits that cover some in-network vision exams and a pair of glasses or contacts each year, up to an annual limit.

3. Hearing loss? You must pay for hearing aids yourself

Medicare covers ear-related medical conditions, but original Medicare and Medigap plans don’t pay for routine hearing tests or hearing aids. ​

Medicare Part B does cover diagnostic hearing and balance (fall risk) exams if ordered by your doctor or another care provider to determine if you need medical treatment. But original Medicare won’t pay for hearing aids or the exams needed to fit them.

The fix. If you are in a Medicare Advantage plan, check your policy to see if it covers hearing-related needs. If it doesn’t, or if you have original Medicare, consider buying insurance or a membership in a discount plan that helps cover the cost of such hearing devices.

Two of the big three warehouse clubs — Costco and Sam’s — sell prescription hearing aids. You don’t have to be a member to receive a free hearing test, but you must to buy the devices.

Also, over-the-counter hearing aids are now available for people with mild to moderate hearing loss.

4. Most chiropractor services won’t be covered

Original Medicare pays for just one chiropractic service: manual manipulation of the spine to correct a vertebral subluxation, which is a partial dislocation of a spinal vertebra from its normal position.

Medicare does cover chiropractic care in certain limited circumstances, such as for pain management and physical and occupational therapy, when a medical doctor prescribes it.

No other services or tests ordered by a chiropractor are covered, including X-rays.

The fix. Some Medicare Advantage plans will cover chiropractic services, so check with your plan. Some chiropractors offer payment plans to help you pay for this care.

5. Bankroll elective cosmetic surgery yourself

Medicare generally doesn’t cover elective cosmetic surgery, such as facelifts or tummy tucks. It will cover plastic surgery after an accidental injury or, if needed, after another treatment, such as breast reconstruction following a mastectomy.

You may need prior authorization before Medicare will cover some procedures to show that it is medically necessary, rather than for cosmetic purposes. If your doctor says you need a rhinoplasty because you’re having trouble breathing, and not because you want a nose job, Medicare may pay.

The fix. If you face these costs, you also may want to set up a separate savings program for them. Some plastic surgeons offer finance plans through medical lenders, but interest rates will be closer to credit card rates than what you’re getting at the bank.

6. No massage therapy, even for chronic pain

​Original Medicare doesn’t cover massage therapy, often used to help reduce chronic pain. Research suggests it may not provide long-term relief.

Some Medicare Advantage plans might cover some massage therapy. Call your plan to find out.​​

The fix. Ask your health care provider to recommend a pain management strategy that Medicare will pay for. If you are set on getting massage therapy, you’ll likely have to pay for it yourself.

7. You’re on your own for a podiatrist’s routine foot care

Routine medical care for feet, such as callus removal, is not covered. Medicare Part B does cover foot exams or treatment related to nerve damage because of diabetes or foot injuries or ailments, such as bunions, hammertoe and heel spurs.

The fix. If you face these costs, you may want to set up a separate savings program for them.

8. Add insurance to your dream vacation overseas

Original Medicare and most Medicare Advantage plans offer virtually no coverage for medical costs outside the U.S. ​​ These expenses can be quite high if you need emergency air transportation to a hospital.

The fix. Some Medigap policies cover certain overseas medical costs, typically paying 80 percent of the billed charges for specific medically necessary emergency care you receive outside the U.S. after a $250 annual deductible. Medigap’s foreign travel emergency coverage has a lifetime limit of $50,000.

In addition, some travel insurance policies provide basic health care coverage — but they may exclude preexisting conditions, so check the fine print. Finally, consider medical evacuation, also known as medevac, insurance for adventures abroad. It will help pay to transport you to a nearby medical facility or back home to the U.S. in case of emergency.

9. Long-term care often comes out of your pocket

​Medicare pays for limited stays in rehab facilities — for example, if you have a hip replacement and need inpatient physical therapy for several weeks. But if you need long-term help with the activities of daily living in a nursing home or assisted living center, you will have to pay the costs yourself.

Nursing homes average about $90,000 a year for a semiprivate room and more than $100,000 for a private room. Costs vary based on where you live and what place you choose.​​

The fix. Lots of decisions go into planning for nursing home care. Some people buy long-term care insurance, and others include these potential costs in their retirement plans.

Veterans may have access to some long-term care programs.

For those with limited income and savings, Medicaid might help fill in the gaps. About a third of the money that the joint federal-state program pays out is used for long-term care.

10. If you want concierge care, you’ll pay extra

Some physicians and their practices require a membership fee. They advertise that this makes them more responsive and available to their patients.

The fees, which can run in the thousands of dollars a year, vary depending on the concierge or boutique practice. Medicare will not cover these fees.

Once you’ve paid that fee, if your doctor participates in Medicare, that physician must offer all the services Medicare does with the same copays and coinsurance rules.

The fix. You can either pay the fee or find another doctor. You might talk to your physician about the terms of when you have to pay. Some states have laws that provide consumer protections for these arrangements.

This story, originally published Aug. 8, 2018, was updated with new information and additional links.