4 Services Medicare Doesn’t Cover and 5 it Does

Original Medicare pays for many procedures and equipment, but you may be surprised to learn that it doesn’t cover most eye doctor, dentist, or hearing aid costs. There are also rules around the rental of durable medical equipment (DME) like oxygen equipment.

If you want to be sure you’re covered for eye, dental, and hearing coverage, you may want to consider an Advantage plan. An Advantage plan can pay for equipment or services that original Medicare isn’t allowed to.

Go through the list below and see if you’ll need additional coverage. Some people rarely use these services, so prefer to pay out-of-pocket for these. Others would rather have the predictable monthly cost that an Advantage plan allows.

How much does Medicare pay for glasses?

Medicare Part B doesn’t pay for glasses or contacts most of the time. Eyeglasses and contact lenses are not covered by Original Medicare. The exception is if you have just had cataract surgery with an intraocular lens. In that case, you’ll pay your deductible plus 20% copay.

How much does Medicare pay for eye exams?

Medicare does not pay for routine eye exams. You will pay out of pocket for 100% of routine eye exams, eyeglasses, or contact lenses.

If you have diabetes, Medicare will pay for you to receive an eye exam to check for diebetic retinopathy once a year. Your deductible and 20% copay will apply.

If you’re at risk for glaucoma, you may get a glaucoma test once every 12 months. Your deductible and copay will apply.

How much does Medicare pay for dental care?

Medicare does not pay for you to see the dentist. Regular cleanings, fillings, dentures, bridges, and other dental work will come 100% out of your pocket.

How much does Medicare pay for hearing aids?

Medicare does not pay for you to see an ENT (Ear Nose and Throat doctor) to be checked for hearing loss, nor does it pay for the hearing aids themselves. If you want hearing aids, you will have to pay 100% out of pocket.

4 Services Medicare Doesn’t Cover and 5 it Does 1

How much does Medicare pay for preventive testing?

Medicare has a list of preventive services that it will cover 100%. Some are yearly, and some occur every few years. Be sure you’re taking advantage of all the screenings available to keep you healthy- especially the Yearly Wellness Visit. During this visit your doctor will create a plan for you around your health so it’s easy to stay on track and get treated or tested for any health concerns.

Does Medicare cover a wheelchair?

If your doctor says a wheelchair is necessary for movement around your home, Medicare Part B may pay for it. You’ll be responsible for your deductible and 20% copay. The wheelchair can be a power-operated (electric) scooter, or a power wheelchair if a scooter won’t meet your needs.

Your doctor and the wheelchair provider must both be enrolled in Medicare, and you may need prior authorization from Medicare. If you just need a wheelchair to move around in public spaces, Medicare will not cover it. If you’ll just need a wheelchair on a temporary basis, Medicare may help pay to rent it.

Does Medicare cover a walker?

Medicare does cover a walker if it has been prescribed by your doctor. You’ll have to pay your deductible and 20% copay. Again, make sure the provider is enrolled in Medicare and accepts assignment.

How much does Medicare pay for home health care?

As long as you meet the requirements of Medicare, your plan will pay for 100% of part-time home health care services. If you need durable medical equipment as part of your treatment, you will pay 20% of that cost.

How much does Medicare pay for a sleep study and CPAP machine?

Medicare pays for most sleep studies, though the Type I test must be done in a sleep lab to be covered. If a CPAP machine is ordered by your doctor, Medicare will cover that as well. Both are subject to your deductible and 20% copay.

Does Medicare Cover Oxygen Equipment?

Medicare will cover oxygen equipment rental when certain conditions are met and your doctor prescribes the equipment. You will have to pay your deductible and 20% copay.

The details surrounding equipment rental, servicing, and ownership is strict, so be sure to ask your doctor and the supplier when you will be charged again.

Will Medicare cover costs if I’m traveling outside the US?

Medicare doesn’t usually cover you if you find yourself needing care outside of the United States. Some exceptions are:
-If you’re on a cruise ship and within 6 hours of a US port
-You have a medical emergency in the US, but a foreign hospital is closer
-You’re traveling to or from Alaska from a US state and a Canadian hospital is closer. You must be traveling “without unreasonable delay”.

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There are many common health issues that Medicare covers, and your deductible and copay apply in most situations. If your copays are adding up to more than your wallet can handle, come talk to us. There are many Advantage and Supplement plans that offer less out-of-pocket expenses so you can manage your budget better on a monthly basis. We can look at your current prescription and doctor needs and help you find the plan that’s right for you.

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Adam works with Medicare clients to answer questions, assist with enrollment, and run plan comparisons to find the right one for your needs.

He’s also an expert in Dual Enrollment for those on both Medicare and Medicaid.

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