What Is Not Covered By Medicare?

There is a common misconception that once you qualify and get Medicare, you no longer need to worry about medical expenses. Unfortunately, Medicare does not cover all of the costs of senior healthcare. In fact, you will still have deductibles, copays, and coinsurance costs — and there are some common healthcare services that Medicare doesn't cover. Fortunately, there are strategies for managing the costs.

What Is Not Covered By Medicare?

Original Medicare (Parts A and B) doesn't cover many routine types of healthcare services, including:¹

• Custodial care: Care provided in a nursing home (unless post-hospitalization) or by in-home healthcare providers, including help with daily living, such as help dressing or bathing.
• Most types of dental care: Original Medicare excludes preventive dental care (cleaning and X-rays), cosmetic procedures (teeth whitening or straightening), dentures, and most procedures to correct dental problems.
• Vision exams: Eyeglasses and contact lenses are not covered.
• Cosmetic surgery: Any procedure considered cosmetic is excluded.
• Routine foot care: Neither exams nor corrective care will be covered for most foot problems.
• Alternative therapies: This includes acupuncture, maintenance chiropractic care, and certain other alternative procedures.
• Hearing aids: Neither hearing aids nor exams to fit hearing aids are covered.

Medicare Patients Also Incur Other Out-Of-Pocket Expenses

Even when healthcare services are covered by Medicare, it won't typically pay 100% of the bills. You will likely have copays, as you would with other health insurance policies.

Here are some common expenses you can plan on for each type of Medicare plan.

Medicare Part A

Generally used for hospitalization.

• You must meet a deductible each year. In 2023 the deductible is $1,600.
• If you are in the hospital for 60 days or more, you must pay “coinsurance" of $400 per day until you reach 90 days. At that time, the daily coinsurance rate rises to $800 per day. You can then use up to 60 “reserve days" – days of coverage you get to bank until needed – however, you must pay $800 per day.
• After you exhaust your reserve days, you must pay all costs.²

Medicare Part B

Typically used for physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.

• You must pay a deductible each year ($226 in 2023) before your coverage kicks in.
• After you meet your deductible, you must pay 20% of Medicare-approved services.²

Medicare Part C

Known as Medicare Advantage, is purchased from private insurers.

Medigap plans help you cover the costs not covered by Medicare including deductibles, copays, and coinsurance. You purchase it from private companies, so costs and coverage vary by plan. Be sure to compare offerings.

Saving Money for the Specific Purpose of Covering Healthcare Costs

You can use money from savings to help cover costs Medicare won't pay for. This may include withdrawing from a 401(k) account, a dedicated Health Savings Account (HSA), or other retirement accounts if you invested in these while employed.

Medicare Savings Programs

If you meet certain income requirements, your state may help you pay for your Medicare Parts A and B premiums, deductibles, and copays. There are four types of Medicare Savings Programs.

1. Qualified Medicare Beneficiary (QMB)

Helps pay for Part A and Part B premiums, deductibles, coinsurance, and copayments. You also will pay no more than $4 for each covered prescription drug.³

2. Specified Low-Income Medicare Beneficiary (SLMB) Program

Helps pay for Part B premiums. You also will pay no more than $9.85 for each covered prescription drug.³

Income limits for QMB and SLMB programs vary. In 2022 the limits for an individual were $1,269 of income per month with resources (savings, money in a retirement account, stocks, bonds) of $7,730 or less. For a married couple the limit in 2022 was $1,851 of income per month with resources of $12,600 or less.³

3. Qualified Individual Program (QI)

Helps pay Part B premiums. States approve applications on a first-come, first-served basis and you must apply each year. You also will pay no more than $9.85 for each covered prescription drug.³

Income limits for QI can vary. In 2022 the limits for an individual were $1,549 of income per month with resources (savings, money in a retirement account, stocks, bonds) of $8,400 or less. For a married couple the limit in 2022 was $2,080 of income per month with resources of $12,600 or less.³

4. Qualified Disabled Working Individual (QDWI) Program

Helps pay Part A premiums for people who have a disability, are working, and who lost Social Security disability benefits and Medicare premium-free Part A benefits because they returned to work.³

Income limits for QDWI can vary. In 2022 the limits for an individual were $4,615 of income per month with resources (savings, money in a retirement account, stocks, bonds) of $4,000 or less. For a married couple the limit in 2022 was $6,189 of income per month with resources of $6,000 or less.³

Medicare Savings Programs are run by each state. Find your state's contact information here.

Managing Healthcare Costs with the CareCredit Credit Card

If you are looking for an option to help manage your medical bills, consider healthcare financing with the CareCredit credit card. The CareCredit card can help you pay for the care you want and need and make payments easy to manage.* Apply today and use our Acceptance Locator to find a provider near you that accepts CareCredit. Continue your wellness journey by downloading the CareCredit Mobile App to manage your account, find a provider on the go, and easily access the Well U hub for more great articles, podcasts, and videos.

Our Expert Reviewer

Patty Caballero and her team of consultants together have more than 35 years of health insurance knowledge working for some of the biggest health insurance companies in the US. She has knowledge in building brands and strategic initiatives to help consumers better understand their health benefits.