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kiticʔa
neck
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Items Not Covered By Medicare Part A, B, and D (Sampling)

The following is not a comprehensive list of non-covered services, and the coverage of certain items below varies by Medicare plan.

 

  • Prescription drug copays (varies by drug and by tier)
  • Some specialty medications are either not covered at all, or require a very large co-pay from the member. Example: Enbrel and Remicade; both covered with high member co-pay. (Also beginning in early 2016, prescribers will have to enroll in Medicare in order to be able to prescribe for Medicare patients. If the provider is not enrolled, a 3 month provision of medication can be obtained while prescriber enrolls or member searches for a new provider who is enrolled)
  • Some durable medical equipment items
  • Long-term care.
  • Most dental care.
  • Eye exams relating to prescribing of glasses.
  • Dentures
  • Hearing aids and fitting for them
  • Routine foot care
  • Routine chiropractic care
  • Plan deductibles, coinsurance and copayments.
  • Some mental health partial hospitalizations, and within those, the following are NOT covered: meals, transportation to and from, support groups, and testing or training for job skills unless part of treatment, a daily coinsurance payment as well as a percentage of total cost.
  • The following home health related services: 24 hour-a-day care, meals delivered to your home, homemaker services, and personal care. (For any service under home health care to be covered, member must be home bound).
  • Some aspects of clinical trial participation, such as the new item or service which is being tested (unless Medicare would cover it if member was not in a trial), items or services only used to collect data and not in direct medical care, such as monthly CT scans, etc., coinsurance and deductibles.  
  • Private duty nursing.
  • Private room unless medically necessary.
  • Personal care items such as razors, slipper socks, etc.
  • $1260 deductible for each benefit period on in-patient hospital stays (this goes up to $1288 in 2016)
  • On inpatient hospital stays from 61-90 days, a $315 daily coinsurance.
  • On inpatient hospital stay beyond 91 days, $630 coinsurance per each "lifetime reserve day" after day 90 for each benefit period. Beyond lifetime reserve days, all costs are the member's.

THIS IS NOT AN ALL-INCLUSIVE LISTING.  Please refer to medicare.gov or your state's Medicaid website for a more complete listing.