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Certain services like routine dental, vision, prescription drugs (Part D), and other benefits are not covered by Original Medicare. There are also deductibles and copays on some medical coverage.
With few exceptions, Original Medicare Parts A and B don’t cover prescription drug costs. You should get prescription drug coverage as soon as you’re eligible for Medicare, unless you have creditable drug coverage that is as good as Medicare’s from somewhere else. This could be with a spouse’s employer-sponsored health plan. If you enroll later, you may be subject to a late enrollment penalty.
There are two options for Prescription Drug coverage, also known as Part D. The first is a stand-alone Part D Prescription Drug plan, which can only be added to:
You can enroll in a Medicare Advantage Prescription Drug plan, which combines all the benefits of Part A and Part B coverage with Prescription Drug coverage (Part D). You’ll get your Part A and Part B coverage through the plan instead of Original Medicare. Without this coverage, you could have to pay 100% of the cost of your prescriptions.
Original Medicare does not cover most dental care, but you can get separate dental coverage from a private insurance company. If you choose not to purchase dental insurance, you could have to pay 100% of the cost of your dental care.
Part B covers a simple vision test as part of the “Welcome to Medicare” visit, but it’s only offered once during your first year of Part B coverage. Part B also covers a yearly eye exam for those living with diabetes to check for diabetic retinopathy, as long as it’s done by a licensed eye doctor.
Eye exams for diagnostic purposes, such as testing for glaucoma or macular degeneration, may also be covered. If treatment may improve a chronic eye condition and is viewed as necessary by a physician participating in Medicare, Part B may cover it. You’ll need to check with your doctor to see if your condition is deemed medically necessary.
Most regular vision care, like routine eye exams, eyeglasses, contacts, and elective vision correction procedures, won’t be covered by Original Medicare. You can purchase separate vision coverage from a private insurance company. If you choose not to purchase vision coverage, you could have to pay 100% of the cost of your vision care.
Part B covers diagnostic hearing and balance exams if ordered to determine whether medical treatment is needed. However, Original Medicare does not cover hearing exams, hearing aids or fittings. You can purchase separate hearing coverage from a private insurance company. If you choose not to purchase hearing coverage, you could have to pay 100% of the cost of your hearing care.
Original Medicare covers some in-home health services, like skilled nursing care, physical therapy, speech pathology, and occupational therapy. Original Medicare will not pay for 24-hour in-home care or meals delivered to you at home. If your in-home care needs are more than what can be classified as part-time or intermittent skilled nursing care, they may not be covered.
You may be responsible for paying 100% of the cost of services that aren’t covered by Original Medicare including most prescription drugs, dental, vision, hearing, and certain in-home care.
This is not a full summary of Original Medicare coverage, benefits, and costs. For a full list of covered services use the “Is my test, item, or service covered?” search tool on Medicare.gov.