What Do Medicare Parts A and B Not Cover?

Millions of older Americans receive their health insurance through the Medicare program. The base type of this coverage is called “Original Medicare,” which consists of two types of coverage: Medicare Part A and Medicare Part B.

Parts A and B form the core of most Medicare plans. However, they are not all-inclusive and won’t cover every type of care someone might want. You must set up your Medicare portfolio appropriately to always get maximized benefits.

What Is Medicare Part A and Part B?

Original Medicare benefits cover most of the essential health care services policyholders need.

Medicare Part A covers most care at hospitals or inpatient centers. Coverage can apply to the costs of overnight hospital stays, surgeries or care received in mental health facilities, nursing homes, rehab and long-term care facilities. It can also pay for certain home health services.
Medicare Part B pays for medically necessary care services. These might include checkups, immunizations, imaging and other wellness care.

Both Part A and Part B coverage have clear rules on when they will pay for care. Therefore, just because you see a doctor doesn’t mean that Original Medicare will pay.
Man Getting Doctor Exam

Restrictions to Original Medicare

There are many situations where Original Medicare won’t pay for some or all your care. Keep these possible coverage restrictions in mind:

Deductibles will apply to certain procedures. As a result, you must pay the cost of your deductible before your policy will cover the cost of certain care.
Original Medicare does not cover most prescription drug costs. It will only pay for prescriptions in limited cases.
Only certain physicians and hospital networks accept Medicare. If you visit a doctor who does not accept Medicare, then your plan won't pay.
Medicare sets different cost sharing requirements on different services. You might have to pay copayments and/or coinsurance obligations when receiving care.

Dental, vision and hearing care do not have coverage in most cases.
Medicare might require you to receive preapproval for certain care. If you don't have preapproval, then Medicare won't pay for your claim.
If you receive care that Medicare does not consider medically necessary, then your plan will not pay.

Expanding Medicare Coverage

There are ways to get expanded coverage for certain care, such as prescription drugs, dental or vision care. For instance, you might be able to buy a Medicare Advantage plan. This is private insurance that offers Part A and B coverage, but might also offer benefits for prescriptions, dental, vision and related care. Or you might choose Medicare Part D prescription drug coverage. You can use this private plan to tack a prescription benefit onto your Original Medicare.

However, you’ll have to qualify for these plans once you get your Original Medicare. Therefore, consider Original Medicare your steppingstone towards comprehensive health benefits.

What Do Medicare Parts A and B Not Cover?

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