Medicare Coverage: What does Medicare Cover? (cont.)

For some of these services, you might have to pay a deductible, coinsurance, or co-payment. The costs will vary depending on the services you need and the type of Medicare plan you have.

Not Covered by Medicare A or B

With a few exceptions, these things are not covered by Medicare Parts A or B:

  • Prescription drugs (Medicare Part D will cover drugs starting in 2006)
  • Long-term nursing home care, if you only need help with daily activities
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and hearing exams
  • Eyeglasses and eye exams
  • Foot care
  • Diabetic insulin and syringes - will be covered under Part D
  • Health care outside the United States
  • Dental care and dentures
  • Routine or yearly physical exams (If your Part B coverage begins on or after January 1, 2005, Medicare will cover a one-time only physical exam within the first 6 months of coverage.)
  • Custodial care (help with bathing, dressing, eating, and using the bathroom)
  • Orthopedic shoes

Medicare Advantage (formerly called Medicare + Choice)

Medicare Advantage plans are health insurance policies you can buy from private companies. A Medicare Advantage plan replaces your traditional Medicare plan. They must offer all the services that traditional Medicare does. Medicare Advantage plans may also offer:

  • Prescription drug benefits
  • Dental Services
  • Hearing examinations and hearing aides
  • Eye examinations and glasses
  • Additional preventive services

To find and compare Medicare Advantage plans offered in your area, use Medicare's Personal Plan Finder.

New Drug Benefit

Prescription drugs will be covered by Medicare starting in 2006. Until then, you can save money on prescriptions by buying a drug discount card.

  • Discount cards are intended to save 10% to 25% on prescription drugs.

To find out about buying a discount card, use Medicare's Drug Discount Card tool, or call (800) MEDICARE ((800) 633-4227).

You may also qualify for a credit to pay for prescriptions. Single people who make $12,919 a year or less, and married couples with an annual income of $17,320 or less are eligible.

Reviewed by Cynthia Haines, MD, August 2005.

SOURCES: Centers for Medicare and Medicaid Services. web site. National Council on the Aging web site.

For additional Medicare information, please read the following articles:

Last Editorial Review: 12/9/2005

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