What extra benefits does Medicare not cover?

Original Medicare (Part A and B) does not cover long-term care (custodial care), most dental care (cleanings, fillings, dentures), eye exams for glasses, dentures, routine hearing exams, hearing aids, cosmetic surgery, and routine foot care. It also excludes most chiropractic services, acupuncture, and services outside the US.

What are the 6 things Medicare doesn't cover?

Some of the items and services Medicare doesn't cover include:

• Eye exams (for prescription eyeglasses)
• Long-term care.
• Cosmetic surgery.
• Massage therapy.
• Routine physical exams.
• Hearing aids and exams for fitting them.

What extra benefits are not covered by traditional Medicare?

Original Medicare doesn't cover some services, like routine physical exams, eye exams, and most dental care. Plans must cover all medically necessary services that Original Medicare covers.

Is it better to go on Medicare or stay on private insurance?

Neither Medicare nor private insurance is universally "better"; the best choice depends on individual needs, but Medicare often offers lower overall costs and simplicity for seniors, while private insurance excels in covering dependents and potentially offering more choice with networks/out-of-pocket caps, though at higher premiums. Medicare boasts lower admin costs and standardized coverage, but Original Medicare lacks an out-of-pocket maximum, a feature typically found in private plans and Medicare Advantage (Part C). 

What is excluded from Medicare coverage?

Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Other services not covered by Medicare Parts A and B include: Routine physical exams. Cosmetic surgery.

5 Things Medicare Doesn't Cover (and how to get them covered)

What does Medicare not pay for seniors?

Original Medicare (Parts A & B) generally doesn't cover routine dental, vision (like eyeglasses/contacts), hearing aids, most long-term care, cosmetic surgery, or most prescription drugs, and it excludes personal/custodial care (bathing, dressing) if it's the only care needed, but Medicare Advantage Plans (Part C) or Part D plans often fill these gaps with extra benefits like dental, vision, and drug coverage, though you pay premiums. 

What is a list of exclusions?

An exclusion list is a roster of individuals, companies, or items deliberately kept out of a group, process, or system, preventing them from participating or being included, often due to misconduct, risk, or specific criteria, like the OIG Exclusion List in healthcare or domains blocked by advertisers. These lists ensure compliance, manage risk, and align with ethical standards, preventing funds from going to bad actors or keeping unwanted content/entities away. 

What are the biggest mistakes people make with Medicare?

The biggest Medicare mistakes involve missing enrollment deadlines, failing to review plans annually, underestimating total costs (premiums, deductibles, copays), not enrolling in a Part D drug plan with Original Medicare, and assuming one-size-fits-all coverage or that Medicare covers everything like long-term care. People often delay enrollment, get locked into old plans without checking for better options, or overlook financial assistance programs, leading to higher out-of-pocket expenses and penalties. 

What is the best health insurance for seniors on Medicare?

There's no single "best" health plan, as it depends on your needs, but top providers for Medicare Advantage (Part C) include Humana, UnitedHealthcare, Aetna, and BCBS, offering diverse benefits like $0 premiums, extra perks, and strong networks, while Medigap (Medicare Supplement) complements Original Medicare by filling gaps, with popular carriers like AARP/UHC, Anthem, and Cigna providing standardized policies (Plans G, F, N), with personalized choices best found via your State SHIP counselor or broker. 

Does Medicare cover 100% of hospital bills?

No, Original Medicare (Part A & B) does not cover 100% of hospital bills; beneficiaries pay deductibles, coinsurance, and copays, but you can get full coverage by adding Medicare Supplement (Medigap) plans or choosing a Medicare Advantage plan. Part A covers the first 60 days of a hospital stay (after a deductible), but after that, you pay daily coinsurance, and there's no limit on your total costs unless you have supplemental coverage.
 

What is the best supplemental insurance for Medicare?

Best Medicare Supplement Insurance Companies in 2026

• UnitedHealthcare / AARP – Best Plan Pairing: Plan G or Plan N.
• Cigna Healthcare – Best Plan Pairing: Plan G.
• Humana – Best Plan Pairing: Plan N.
• Aetna (CVS Health) – Best Plan Pairing: Plan N.

Does Medicare pay for a colonoscopy?

Yes, Medicare (Part B) pays for screening colonoscopies, covering 100% of costs if your doctor accepts assignment and no polyps are found, though you pay 15% if they remove tissue (making it diagnostic); frequency depends on your risk, generally every 10 years (average risk) or 24 months (high risk). 

What states have the worst Medicare Advantage plans?

States often cited for weaker Medicare Advantage performance include Louisiana, Mississippi, Kentucky, West Virginia, and Florida, due to challenges with care access, provider shortages, and quality issues like higher rates of avoidable hospitalizations and inappropriate medication prescriptions, though specific rankings vary by report and focus (e.g., satisfaction vs. overall system). Other states like New York, California, Texas, and Michigan appear on lists for low member satisfaction with specific plans, not necessarily the whole state's system. 

Does Medicare pay 100% for anything?

No, Original Medicare (Part A & B) does not cover 100% of costs; it typically pays about 80% after deductibles, leaving you with 20% coinsurance for many services, plus gaps like dental, vision, and most drugs, requiring you to pay out-of-pocket or get supplemental coverage like Medicare Advantage (Part C) or Medigap. Some preventive services are covered at 100%, but most care has cost-sharing. 

What changes are coming to Medicare in 2026?

In 2026, Medicare brings lower Part D drug costs with a new $2,100 out-of-pocket cap, continued insulin price caps, and lower negotiated prices for some drugs, alongside rising Part B premiums and deductibles for Original Medicare, and changes to MA plans focusing on behavioral health and new benefits for chronic conditions, all driven by the Inflation Reduction Act. 

What blood tests does Medicare not cover for seniors?

Medicare generally doesn't cover routine wellness blood panels, employment-related tests, or self-requested tests without medical necessity; it focuses on medically indicated diagnostics, not general curiosity or unproven functional medicine tests, though it covers many specific screenings like PSA, lipid panels (periodically), and thyroid tests if ordered by a doctor due to symptoms or risk factors, requiring an Advance Beneficiary Notice (ABN) for potentially non-covered tests. 

What insurance provider denies the most claims?

In 2023, roughly one third of all in-network claims made to AvMed were denied by the medical insurance company. In this year, AvMed and United HealthCare were the medical insurance companies with the highest denial rate for in-network claims in the United States, at 33 percent each.

How do I get dental and vision coverage with Medicare?

If you have a Medicare Supplement plan, Part D plan, or both, you may want to purchase an Individual plan to cover dental and vision care. Most Anthem Medicare Advantage plans include built-in coverage for routine dental and vision care.

Is Blue Cross or UnitedHealthcare better?

UnitedHealthcare gets slightly higher overall star ratings than BCBS and may offer lower prices, but BCBS might offer a better customer experience.

What are the three words to remember for a Medicare wellness exam?

For a Medicare Wellness Exam's cognitive test, the three common words to remember are often "banana," "sunrise," and "chair," used in the Mini-Cog screening to check your memory and thinking skills; you say them immediately and then recall them after a few minutes. 

Why are doctors dropping Medicare patients?

Physician Medicare reimbursement dropped 33% since 2000, when adjusted for inflation, according to the AMA. As a result, Ferguson said, many practices—particularly small, independent ones—can no longer afford to absorb the losses. "It's gotten to a point where you can't absorb it.

Is it better to have plain Medicare or Medicare Advantage?

Neither Original Medicare nor Medicare Advantage (MA) is universally "better"; the best choice depends on your healthcare needs, budget, and preference for provider choice, with Original Medicare offering nationwide provider freedom but requiring separate drug/supplement plans, while MA provides all-in-one coverage with networks and extra benefits like dental/vision but often requires referrals and has regional limits. 

What is the Medicare exclusion list?

The Medicare Exclusion Database includes data about individuals and entities that have been precluded from billing Medicare due to being assessed a penalty, owing an outstanding debt, or being subject to a Medicare payment suspension for (for example) fraudulent billing, overcharging, providing substandard care, or non ...

What are permanent exclusions?

Permanent Exclusions are categories of treatments and ailments that are never covered under a health insurance policy; they are excluded permanently. Time-Bound Exclusions (or temporary exclusions) are healthcare costs or medical expenses that are not covered for a specified duration (the waiting period).

What are some examples of social exclusion?

Social exclusion examples include racial/ethnic discrimination, like Indigenous communities being denied rights; economic barriers, such as homelessness or low wages; disability-based exclusion, like inaccessible buildings or job discrimination; digital exclusion, missing out on online services; and cultural exclusion, like LGBTQ+ individuals facing discrimination in public spaces. It's a process where individuals or groups are shut out from full societal participation, often due to linked issues like poor housing, lack of education, and limited opportunities, leading to isolation and reduced access to resources.