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5 Services Medicare Won’t Pay For

By Lisa ZamoskySeptember 27, 2012
From the WebMD Archives

I often receive questions asking about the various types of services covered by Medicare.

Knowing what to look for in a Medicare plan is critical to getting the health benefits you need. But it’s equally important to understand what Medicare does not cover.

Here are five services Medicare won’t pay for.

1. Medicare and skilled nursing care:

Medicare will help cover the cost of a skilled nursing home for up to 100 days (you’ll pay no co-pay for the first 20 days and then a daily rate from days 21-100), but only if you’ve spent at least three consecutive days in the hospital as an inpatient and you’re admitted to the skilled nursing facility within 30 days of your hospital stay.

Most people use their own financial resources to pay for nursing home care. Over time, when their resources are depleted, they become eligible for Medicaid, which will cover the cost.

Long-term care insurance is one important protection against huge costs down the road. If you’re in your 50s or 60s, now is a good time to review your options.

2. Home care: If you need help bathing, getting dressed, and making meals while living at home, you’ll have to meet a number of criteria in order for Medicare to pay for the cost. Generally, only people who are confirmed by a doctor to be homebound and in need of skilled nursing care will qualify for Medicare-covered home health services. Otherwise, you’re on your own financially.

Here again, long-term care insurance, if you have it, can help to defray the cost.

3. Dental and vision care: Medicare does not cover the cost of dental care or eye glasses, except when glasses are needed following surgery to remove cataracts. Some Medicare Advantage plans do include vision coverage as an add-on, but traditional Medicare does not.

And for help paying the cost of your dental care, you’ll need to search for a separate dental insurance plan or find other ways of lowering your costs.

4. Alternative medicine: Alternative treatments such as acupuncture or chiropractics for the prevention of illness or health maintenance are not covered by Medicare. Medicare will pay for chiropractic care only in cases in which manual manipulation is done by a licensed chiropractor to correct a subluxation of the spine — when one or more of the bones of the spine are dislocated.

5. Out-of-area care: If you’re retired and travel a lot, you need to be careful about the Medicare coverage you choose. With traditional Medicare, you can get coverage for medical treatment if you’re hospitalized or need to see a physician while you’re away from home. But if you travel overseas and get sick, you’re out of luck. Medicare won’t pay for health care you receive outside of the country.

In addition, people with Medicare Advantage plans generally need to see doctors within the plan’s network. Check with your plan to find out the rules for getting care when you’re away from home.

Your turn: What services have you been surprised to find Medicare won’t pay for? Please let us know in the comments section below.

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