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

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 $1,364 
Hospital days 61-90 You pay $335 per day
Hospital Days 91-150 You pay $670 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 $167.50 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 $185
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%

 

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