What’s not covered by Part A & Part B?

 

 Medicare doesn’t cover everything. Some of the items and services Medicare doesn’t cover include:

• Long-term care (also called custodial care )
• Most dental care
• Eye exams related to prescribing glasses
• Dentures
• Cosmetic surgery  
• Acupuncture  
• Hearing aids and exams for fitting them
• Routine foot care

Medicare Part A doesn’t cover everything. Also, some services that you might expect to be covered by Part A are instead covered under Part B.

Part A does not cover the following: 

• A private room in the hospital or a skilled nursing facility, unless medically necessary.
• Private nursing care.
• A television or telephone in your room, and personal items like razors or slipper socks, unless the hospital or skilled nursing facility provides these to all patients at no additional charge.
• The first three pints of blood, unless the hospital gets it from a blood bank at no charge, or you arrange to replace it by donating your own or somebody else’s blood, or you have additional insurance (such as Medigap) that covers this cost. 
• The cost of staying in a skilled nursing facility (where you might need to go for continued nursing or rehab work after being discharged from the hospital) if you are enrolled in the original Medicare program and have not spent at least three days in the hospital as a properly admitted inpatient. If you have been in the hospital “under observation” — even for longer than three days — you do not qualify for Medicare coverage of a stay in a skilled nursing facility.  
• The costs of staying as a long-term resident in a nursing home or assisted living facility. Medicare will cover your medical needs in the usual way, but it won’t pay for custodial care — which means help with everyday activities such as dressing, feeding, bathing, going to the bathroom — or for your room or meals. (But long-term care may be paid for under your state Medicaid program if you have exhausted your own savings.) 

Medicare Part B covers a very wide range of medical care — from routine services like flu shots and X-rays to big-ticket items such as organ transplants, delicate surgery to repair serious injuries, expensive cancer treatments and many others. It also covers a variety of preventive measures (such as tests and screenings), often at no cost to you. But there are still some services that Part B does not pay for.

If you’re enrolled in the original Medicare program, these gaps in coverage include: 

• Routine services for vision, hearing and dental care — for example, checkups, eyeglasses, hearing aids, dental extractions and dentures. (However, Medicare covers medically necessary care, such as cataract surgery or jaw reconstruction after a serious injury.)
• Routine services for foot care, such as toenail clipping or the removal of corns and calluses — unless you have foot problems caused by conditions such as diabetes, cancer, multiple sclerosis, chronic kidney disease, malnutrition or inflammation of the veins related to blood clots. (Medicare coverage is provided only if your doctor or podiatrist provides evidence that foot care is medically necessary.)
• Home safety items, such as grab bars in the bathroom, stair lifts or elevators, bathtub lifts or seats, medical emergency alert systems, etc. (Medicare coverage is a available for a few items it deems medically reasonable if a doctor prescribes them — for example, seat lifts to help you get out of a chair or trapeze bars to help you sit up when confined to bed.)
• Long-term care in nursing homes or assisted living facilities. In these situations, Medicare covers your medical needs but does not cover any custodial care, meaning help with daily activities such as dressing, feeding, bathing, going to the bathroom, etc. (Medicare covers short-term care in skilled nursing facilities, which may be nursing homes, when you qualify for continued nursing care and rehab work.)
• Medical services outside of the United States and its territories, except in rare circumstances. 
• Any care that Medicare does not consider medically necessary, such as cosmetic surgery and fitness programs, or regards as alternative medicine, such as acupuncture. 

Note: Medicare Advantage plans, such as HMOs or PPOs, must cover all the same Part B services that the original Medicare program does. But they may also offer extra benefits that cover some of the gaps listed above. Some plans, for example, provide coverage for routine hearing, vision and/or dental care, fitness programs and gym memberships, and emergency care abroad