Navigating the intricacies of Medicare, a health insurance program tailored for individuals aged 65 and older, and those under 65 with specific disabilities, requires an understanding of its limitations. While Medicare, including its two primary components – Part A for hospital insurance and Part B for medical insurance – alleviates numerous medical expenses, there are crucial exclusions. Whether you’re exploring medicare near me options or contemplating medicare enrollment, it’s pivotal to recognize the gaps in coverage. This knowledge becomes particularly vital when anticipating out-of-pocket expenses, such as those related to hearing, vision, and dental care. Here’s a breakdown of seven things that Medicare does not cover:

1. Prescription drugs

The standard Medicare plan lacks coverage for prescription drugs. However, private insurance companies offer alternatives like Medicare Part D Prescription Drug Plans (PDPs) and Medicare Advantage (Part C), which present diverse options for drug coverage.

2. Long-term nursing home care

While long-term care isn’t typically covered by Medicare, certain services within nursing homes, such as medical supplies and physician visits, may still be eligible for coverage. Medicaid can complement Medicare, as most nursing homes accept Medicaid for admissions.

3. Routine eye care, hearing exams, and hearing aids

Original Medicare doesn’t cover routine eye care, hearing exams, or hearing aids. Some Medicare Advantage plans, however, can provide assistance. Vision care, including eye exams, eyeglasses, and contact lenses, remains uncovered.

4. Preventive dental checkups

Routine dental exams, dental work, and dentures are not covered by original Medicare. Some annual limits, such as the common dental limit of $1,500 per year, may still be accessible through Medicare Advantage plans.

5. Medical care for international travel

For frequent travelers, exploring Medigap (supplement plans) is advisable. Certain plans cover costs that Medicare does not, up to 80%. Medicare Advantage plans also extend coverage for emergency medical expenses incurred outside the country.

6. Cosmetic surgery

Medicare excludes coverage for cosmetic surgery, except in specific cases. Instances where coverage might be approved include repairing skin burns, addressing facial injuries post-accident, or undergoing cosmetic surgery for therapeutic reasons.

7. Deductibles and coinsurance

Although Plan A covers hospital stays and Plan B includes doctors’ visits and outpatient care, deductibles and copayments remain the responsibility of the individual. For instance, Plan B covers 80% of doctors’ services, but after a $233 deductible, the remaining 20% is the patient’s responsibility. To address these gaps, Medicare supplement policies prove beneficial.