What is Not Covered By Medicare?

Medicare does not cover many services that patients may think are medically necessary. The things that are not covered by Medicare can be broadly divided into two groups. These are:

  • Medicare procedures and services that are not medically necessary or based on traditional western medical practices.
  • Medicare care that is viewed as maintenance or custodial care.

Medicare does not cover Medical Costs or Procedures that are not necessary

Medicare will not cover any medical costs that are not directly related to your medical care. This can include everything from a private room to a walker that has not been authorized by your doctor. Medicare will also not cover any cosmetic surgeries unless it is related to a severe accident or deformity. Medicare does not cover chiropractic care of any kind nor does it cover acupuncture or acupressure treatment. "Alternative" medicine of any kind is generally not covered by Medicare.

Medicare does not cover most Custodial Care

Original Medicare doesn't pay for help with bathing, feeding, cleaning or dressing. Medicare will not cover any care that is needed to help a person meet their daily basic living needs. In some severe cases such as with severely disabled people and with people that or on hospice care some types of custodial care will be covered.

Medicare does not cover most Maintenance Medical Care

Maintenance Medical Care includes eye care, hearing care, dental care and podiatry care. Original Medicare covers only a very limited amount or nothing in each of these categories. However, several Medicare Advantage Plans do offer coverage for these services. Interestingly if any of these areas of the body are affected by another illness such as diabetes then care is usually covered. Similarly, if a person suffers from acute hearing loss and is in need of an Implant then this procedure will be covered. Dental is covered if the problem is related to an accident or fall. Hearing issues will sometimes be covered if the hearing loss is related to a balance issue.

While today these exclusions seem quite arbitrary they are actually based up on the training of Medical professionals and the way the Medical field developed in the United States. Podiatry, dentistry and vision each developed separately from the traditional medical establishment. Until quite recently hearing issues were largely untreatable and this is why they too are excluded.

Outside of plastic surgery, there are good arguments for including all the coverage that isn't covered under Medicare. However, the exclusions needed to be established somewhere and these are the areas that have been left out of Original Medicare. Luckily some of them are at least partially covered under Medicare Part C Plans.