You would hope that Original Medicare would cover everything you need when you are down and out. After all, you have paid Medicare taxes most of your life and continue to pay monthly premiums and copays. Unfortunately, that’s not how it works out. Here are 9 surprising things Original Medicare doesn’t cover.

1 — Dental care

The American College of Prosthodontists reports that 36 million do not have any teeth and 120 million are missing at least one. This can increase the risk for malnutrition and other conditions. There can be a number of causes for this, ranging from gum disease to trauma.

Despite that, Medicare does not cover routine dental care like cleanings, fillings, root canals, tooth extractions, or dentures (false teeth). It also excludes dental treatments like bridges, crowns, and plates. Cover is limited to dental evaluations before high risk surgeries like heart valve replacement or a kidney transplant. It will also cover dental procedures if they are needed to reconstruct the jaw after a facial tumor is removed or to repair a fracture of the jaw.

2 — Hearing aids

According to the National Institutes of Health, one-quarter of people between 65 and 74 years old and half the people over 75 years old have hearing loss. It may be difficult to interact with others or to respond to warning signs in their environment like car horns and fire alarms. There are also studies that correlate hearing loss with an increased risk for dementia.

Medicare does not cover screening routine hearing exams although it will pay for a test if you have symptoms that need evaluation. Unfortunately, even if a test confirms that someone has hearing loss, Medicare won’t pay for an exam to fit hearing aids and it won’t pay for the hearing aids themselves.

Medicare may not pay for hearing aids, but it does cover cochlear implants if you meet certain criteria. The Catch-22? You first have to show that hearing aids were not effective!

3 — Vision care

According to the Centers for Disease Control and Infection, more than 12 million people over 40 years old have a vision impairment. Poor vision can decrease your ability to perform basic activities like bathing, dressing, or even taking your medication. More complicated activities like cooking or driving could become dangerous. People with vision impairment are also at greater risk for falls. The Centers for Disease Control and Prevention reports that one in four seniors falls every year resulting in 3 million emergency department visits and 800,000 hospitalizations.

Despite all the evidence that supports the need for vision care in seniors, Medicare does not cover routine eye exams or corrective lenses. You will pay for eyeglasses and contact lenses out of pocket. That does not mean that Original Medicare does not cover any vision screening at all. It covers the following services for people with these conditions:

• Age-related macular degeneration (AMD): If you have AMD, Medicare will pay for treatment, including surgical procedures and some injectable medications.
• Cataracts: Medicare covers cataract surgery with implantation of an intraocular lens. This is the rare time that Medicare will also cover a pair of corrective lenses, albeit through a Medicare-approved supplier.
• Diabetes: If you have diabetes, Medicare covers an annual ophthalmology exam to screen for diabetic retinopathy.
• Glaucoma: If you have a family history for glaucoma, have diabetes, are an African American over 50 years old, or are a Hispanic American 65 and older, you are considered to be at risk for glaucoma. Medicare will pay for screening every 12 months.

4 — Long-term care in a nursing home

Not everyone is capable of taking care of themselves as they grow older. While some people can turn to family and friends to help them, many people do not have that option. Even fewer people have enough resources to pay for a nursing home out of pocket, especially when you consider that the average cost for a nursing home in 2022 was $7,908 per month for a shared room and $9,034 for a private room.

Unfortunately, Medicare does not play for long-term stays in a nursing home. While it will pay for short-term placement in a skilled nursing facility after a hospitalization, it only pays for a limited number of days.

5 — Custodial care

Not everyone who needs help taking care of themselves goes to a nursing home. Many people live at home or in assisted living facilities. Regardless of where they live, they may need help performing activities of daily living. This may include anything from bathing to eating to dressing to toileting.

Original Medicare distinguishes between two types of care: skilled care and custodial care. Skilled care requires a licensed medical professional. This can include physical therapy, occupational therapy, speech therapy, and skilled nursing care. Medicare covers these services, regardless of location, but only if they are considered medically necessary and are ordered by a physician.

Custodial care, on the other hand, can be performed by anyone. The care is not medical in nature and does not require a license. A nurse’s aide, for example, may assist with the activities of daily living listed above. Medicare will not pay for these services.

6 — Ambulance rides

If you have ever paid for an ambulance ride, you know it doesn’t come cheap. Costs can range from hundreds to thousands of dollars. Some companies will tack on additional charges for additional practitioners on board (critical care nurses, respiratory therapists, etc.), use of medical supplies (i.e. oxygen masks, bandages, dressings, ice packs, etc.) and mileage among other things.

Even in an emergency, Original Medicare only pays for ground transportation to the nearest hospital, critical access hospital, or skilled nursing facility that can provide care for your situation. If you prefer to go a different nearby medical facility, you will get stuck paying yourself.

7 — White canes for the blind

White canes are used by the visually impaired. They help them navigate their environment and allow them to be independently mobile. It’s hard to imagine that Original Medicare would not consider these white canes to be medically necessary, but it’s true. They’re not covered. Ironically, the United States observes White Cane Safety Day every year on October 15, the same day that the Medicare Open Enrollment Period starts. If you need a white cane, reach out to the National Federation of the Blind (nfb.org) for a free one.

8 — Service animals

Not only does Medicare not cover white canes, it will not pay for service animals that could help people with visual impairments live more independent lives. Specifically, it does not include the cost of obtaining, feeding, or providing veterinary care for the animal. If you or someone you know is interested in a service animal, you may consider turning to Social Security Disability Service Animal Assistance Programs (USA.GOV/disability-financial-support).

9 — Cosmetic services

Medicare does not cover services that are cosmetic in nature. This refers to any services with the intention to improve your appearance, even for weight loss.

 

Cost of Long Term Care by State | Cost of Care Report | Genworth. (2022). Genworth.com. https://www.genworth.com/aging-and-you/finances/cost-of-care.html

Facts & Figures | American College of Prosthodontists. (2017). Gotoapro.org. https://www.gotoapro.org/facts-figures/

Fast Facts of Common Eye Disorders | CDC. (2022). CDC.gov. https://www.cdc.gov/visionhealth/basics/ced/fastfacts.htm

Facts About Falls | CDC. (2022). CDC.gov. https://www.cdc.gov/falls/facts.html

Liu, C.-M., & Lee, C. T.-C. (2019). Association of Hearing Loss With Dementia. JAMA Network Open, 2(7), e198112. https://doi.org/10.1001/jamanetworkopen.2019.8112

Quick Statistics About Hearing | National Institute on Deafness and Other Communication Disorders. (2021). NIDCD.nih.gov. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing