What Does Medicare NOT Cover?

Learn what Medicare doesn't cover and what you can do about it

by Ray Wilson+ on Jun 22, 2019 | 1 Comment

Share this article!

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with permanent kidney failure requiring dialysis or a transplant. You can find out on our site what Medicare covers on our Senior65 site but this page specifically deals with what Medicare does not cover…. and what you can do about it.

What does Medicare not cover?

  • Basically 20% of all your medical costs. (Medicare usually pays 80% so you pay 20%)
  • Any deductible, copay or coinsurance
  • Prescription Drugs
  • Vision
  • Dental
  • hearing
  • First 3 pints of blood
  • Foreign emergency healthcare

For a more exensive list of what Medicare does not cover, scroll to chart at the bottom of this page.

It can be a worrisome list of items that Medicare coverage completely cover. Good news is that you can still get those items covered.

How to address what Medicare doesn’t cover?

Get additional coverage by enrolling in a Medigap plan, a Medicare Advantage plan, and/or a Part D Drugs plan.

Learn More about Medigap Get a Medigap Quote

We cannot provide online quotes for Part D or Medicare Advantage so please contact us if you wish to enroll.

Medicare Fee Details

Benefits What Medicare Makes You Pay
Part A Hospital Benefit Period Deductible You pay $1,408 
Hospital days 61-90 You pay $352 per day
Hospital Days 91-150 You pay $704 per day (lifetime reserve days)
Beyond Lifetime Reserve Days You pay 100% off all costs
Skilled Nursing Facility Care Days 1-20 You pay $0 (Part A deductible applies)**
Skilled Nursing Facility Care Days 21-100 You pay $176 per day
Hospice Respite Care You pay 5%
First 3 Pints of Blood You pay 100% of all costs
Additional Blood You pay $0
Part B Annual Deductible You pay $198
Ambulance You pay 20% (Part B deductible applies)
Doctor Office Copays/Coinsurance You pay 20% (Part B deductible applies)
Durable Medical Equipment You pay 20% (Part B deductible applies)
Part B Excess Charges You pay 100% (Part B deductible applies)
Foreign Travel Emergency You pay 100%
Out-Patient Surgery You pay 20% (Part B deductible applies)
Urgent Care You pay 20% (Part B deductible applies)
Dental You pay 100%
Vision You pay 100%
Hearing You pay 100%


Print Friendly Version

Share this article!

Reader Comments and Questions

By Steve on September 28, 2019

im leaving work next october can I enroll in plan G without answering medical questions if I am 67?

Yes, you can. Once you leave your work coverage you will be able to get any Medigap without going through medical underwriting. Give us a call to get you enrolled at no additional cost to you.
-Michelle from Senior65.com

PLEASE NOTE: We cannot comment on specific Medicare claims. Contact Medicare directly if you are trying to see if your issue is covered.

We will not publish your last name or email if you submit this form.

Share this article!

It's 100% FREE to work with Senior65

Call our licensed agent today at 800-930-7956. Click here to learn 5 great reasons to work with Senior65.com