Long-Term Custodial Care
Not covered
Medicare does not pay for long-term care, also called custodial care, when the main need is help with activities
such as bathing, dressing, eating, toileting, or other daily personal care.
Important distinction: Medicare may cover qualifying short-term skilled nursing facility care and certain
home health services. Skilled care is not the same as ongoing custodial long-term care.
Learn more about
Medicare home health coverage
.
Most Routine Dental Care
Usually not covered
Original Medicare generally does not cover routine dental services such as cleanings, fillings, most tooth extractions,
dentures, or implants.
Exceptions exist: Medicare may cover certain dental services that are directly related to specific covered
medical treatments, including some services connected with organ transplants, heart valve procedures, cancer treatment,
or dialysis for End-Stage Renal Disease.
See our deeper explanation:
Why Doesn't Medicare Cover Dental Care?
Routine Eye Exams and Most Eyeglasses
Routine care not covered
Original Medicare does not cover routine eye exams, sometimes called refractions, for prescription eyeglasses or contact lenses.
It also does not usually cover eyeglasses or contacts.
One important exception: Part B covers one pair of standard-frame eyeglasses or one set of contact lenses
after each covered cataract surgery that implants an intraocular lens.
Hearing Aids and Fitting Exams
Not covered by Original Medicare
Original Medicare does not cover hearing aids or exams performed specifically to fit hearing aids.
Medicare can cover certain diagnostic hearing and balance exams when they are medically necessary. That is different from
routine hearing-aid fitting services.
Routine Physical Exams
Routine physical not covered
Original Medicare does not cover a traditional routine physical exam just because you want a yearly physical.
But Medicare does cover preventive visits: Part B covers the yearly Medicare Wellness visit for eligible
beneficiaries. The Wellness visit is focused on prevention planning and is not the same as a routine physical exam.
Most Cosmetic Surgery
Usually not covered
Medicare generally does not cover surgery performed only to change appearance.
Medical exceptions matter: Medicare may cover procedures needed because of an accidental injury,
to improve the function of a malformed body part, or for certain reconstructive care such as breast reconstruction
following a mastectomy for breast cancer.
Massage Therapy
Not covered
Original Medicare does not cover massage therapy, even when a person uses massage as part of a broader approach to pain management.
Do not assume that every pain treatment is excluded. Medicare coverage depends on the specific service, medical necessity,
provider requirements, and Medicare coverage rules.
Concierge Membership Fees
Membership fee not covered
Medicare does not pay the membership or retainer fee charged by a concierge medical practice.
Covered medical services are different: A concierge doctor who participates in Medicare must still follow Medicare
rules for Medicare-covered services. The membership fee itself is a separate non-covered charge.
Adult Diapers and Incontinence Supplies
Not covered
Original Medicare does not cover adult diapers or incontinence supplies. You generally pay 100% of the cost for these non-covered items.
Some Medicare Advantage plans may offer additional benefits or allowances. Benefit details vary by plan and area.
Health Care Outside the United States
Usually not covered
Original Medicare generally does not cover medical care you receive outside the United States.
Limited exceptions apply: Medicare may pay in certain situations involving a foreign hospital that is closer
than an appropriate U.S. hospital, certain travel through Canada between Alaska and another state, or qualifying care on a cruise ship.
Services From Providers Who Opt Out of Medicare
Generally not paid by Medicare
Medicare generally will not pay for covered items or services you receive from a doctor or other provider who has formally opted out of Medicare.
Emergency exception: Medicare may still cover emergency or urgently needed services in certain situations.
Provider billing rules can be confusing. See
Medicare Assignment, Costs, and Provider Billing
.
Common Supplies Used at Home
Many are not covered
Part B usually does not cover common disposable medical supplies you use at home, such as ordinary bandages and gauze.
Durable medical equipment is a different category. Medicare can cover qualifying equipment, such as certain walkers,
wheelchairs, hospital beds, and other items, when Medicare requirements are met.
