11 things excluded from Medicare coverage
Medicare is a federal health insurance program for people with certain disabilities and people over 65. Original Medicare has two main parts: Part A, which covers the cost of inpatient services, and Part B, which covers the cost of outpatient services and certain medical equipment. Although the program is meant to ease the financial burden of medical costs on people, it can be quite complex to navigate. This article explores 11 things that are excluded from Medicare coverage.
1. Medically unreasonable services and supplies
Any services and supplies deemed unnecessary or unreasonable for diagnosis or treatment are not covered by Medicare. These may include:
- Services that could have been furnished at a lower-cost setting (such as at a nursing home)
- Services that exceed Medicare length of stay limitations
- Excessive therapy or diagnostic procedures
- Unrelated screenings, tests, examinations, or therapies (that the patient has no symptoms for)
- Unnecessary services based on patient diagnosis, such as transcendental meditation
Exceptions to this rule include Medicare preventive services, transitional care management, chronic care management, and advance care planning.
2. Opticians and eye exams
While Medicare covers ophthalmologic expenses (such as cataract surgery), it does not cover the cost of most vision services, including eyeglasses and contact lenses or routine examinations for prescription and fitting.