What’s NOT Covered by Original Medicare?

Original Medicare (Parts A and B) provides essential hospital and medical insurance for millions of Americans, but it doesn’t cover everything. Many beneficiaries are surprised to learn that some routine and critical services are not included. Understanding what’s not covered can help you avoid unexpected expenses and plan for additional insurance if needed.

1. Prescription Drugs

Original Medicare does not cover most outpatient prescription medications. To get drug coverage, you’ll need to enroll in a Medicare Part D plan or choose a Medicare Advantage plan (Part C) that includes drug benefits.

2. Dental Care

Medicare does not cover:

• Routine dental exams

• Cleanings and fillings

• Tooth extractions

• Dentures and implants

To get dental coverage, consider a Medicare Advantage plan with dental benefits or a standalone dental insurance policy.

3. Vision Care

Original Medicare doesn’t cover:

• Routine eye exams

• Glasses or contact lenses

• LASIK or vision correction procedures

However, Medicare does cover certain medically necessary eye services, such as cataract surgery or glaucoma screenings.

4. Hearing Services

Routine hearing exams, hearing aids, and fittings are not covered under Original Medicare. You may need a Medicare Advantage plan or a separate hearing insurance plan to receive these benefits.

5. Long-Term Care

Original Medicare does not cover custodial care (help with bathing, dressing, or eating) if that’s the only care you need. Long-term care in assisted living or nursing homes typically requires:

• Medicaid, if you qualify based on income/assets

• Long-term care insurance or private pay

6. Care Outside the U.S.

Medicare generally does not cover medical care received outside the United States, except in limited emergency situations. Some Medigap plans provide emergency foreign travel coverage.

7. Cosmetic Surgery

Procedures done for cosmetic purposes are not covered unless deemed medically necessary, such as reconstruction after an accident or mastectomy.

How to Fill the Gaps in Coverage

✅ Enroll in a Medicare Advantage (Part C) plan with additional benefits

✅ Get a Part D prescription drug plan

✅ Add a Medigap (Supplement) plan to Original Medicare

✅ Consider standalone dental, vision, or hearing plans

Final Thoughts

Original Medicare is a strong foundation, but it doesn’t cover everything. Knowing what’s not covered can help you plan ahead and avoid surprises. Need help identifying the right supplemental coverage? Lindbergh and Associates is here to guide you.

📞 Call us today or schedule a free consultation to find the right plan for your needs!