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What Does Medicare Not Cover? The Most Common Out-of-Pocket Costs

Medicare Bob
Medicare General Info
Discover what Medicare does not cover, the most common out-of-pocket costs, and how to fill in your coverage gaps.
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Original Medicare — parts A and B — doesn’t cover it all. With Medicare Part A you’re covered for most hospital inpatient services. And Medicare Part B is outpatient medical coverage that takes care of medically necessary services and supplies. But what does Medicare not cover?

Of course, when it comes to Original Medicare, you’ll need to pay your deductible and any applicable coinsurance. These amounts change from year to year, so be sure you have the latest figures when planning your health care.

There are some exceptions, but common services Medicare typically doesn’t cover include:

In addition to the items and services listed above, Medicare doesn’t pay for anything your doctors consider medically unreasonable and unnecessary services and supplies to diagnose or treat your condition. Medicare also doesn’t cover hospital services that exceed length-of-stay limitations, and it only covers the first 20 days in a Skilled Nursing Facility.

If you’re in need of a service not covered by Medicare, you can pay out of pocket or obtain another insurance plan or Medicare policy that can help pay for your needs.

Other Options: Filling the Gaps in Your Medicare Coverage

While Medicare parts A and B don’t cover everything, there are options to take care of some or all of your out-of-pocket costs.

Medicare Part C, or a Medicare Advantage plan — offered by Medicare-approved private companies — often covers items and services not covered under Original Medicare.

Medicare Part D plans can save you money on prescription drugs.

A Medicare Supplement, or Medigap plan, can also help cover some of the services not covered under Original Medicare. Just remember, you won’t be able to enroll in or use a Medigap plan if you’re also under a Medicare Advantage plan.

Check Medicare.gov to see if your test, item or service is covered by Medicare. Or call Senior Healthcare Direct at 1-833-463-3262, TTY 711 to speak with a licensed agent.

For more information on common Medicare out-of-pocket costs, check out the rest of the blogs in our “What Does Medicare NOT Cover?” series:

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LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.

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