Services that Medicare does not cover

Our Medicare benefits were established under the Social Security Amendment of 1965, reflecting the restrictions and limitations of most health insurance at that time. This law excluded coverage for certain things, like dental care and routine vision services. Long-term care is also excluded because these services do not meet the definition of health care services in the law.

Just because something is not covered by Medicare, though, does not mean that it isn’t needed. As I discuss some types of care that Medicare doesn’t cover, I will include information about other ways of accessing or paying for these services. You are also encouraged to call one of our certified counselors at the Medicare Information Office to discuss specific concerns and find resources to help.

Dental and eye care

Medicare does not cover dental services that you need primarily for the health of your teeth, such as routine checkups, cleanings, fillings, most tooth extractions, and dentures. Medicare does, however, offer very limited coverage for some dental care needed to protect particular aspects of your general health, or for dental care needed for another Medicare-covered health service to be successful. For example, Medicare may cover an oral examination in the hospital before a kidney transplant, surgery to treat fractures of the jaw or face, or dental splints and wiring needed after jaw surgery.

Routine eye care services, such as regular eye exams, are also excluded from Medicare coverage. However, Medicare will cover an annual eye exam if you have diabetes or are at high risk for glaucoma. Medicare also covers certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. For example, Medicare covers cataract surgery, as well as eyeglasses or contacts after cataract surgery.

Medicaid and other options

If you have limited income and assets, you may be eligible for Medicaid coverage, which can cover services that Medicare does not. Here in Alaska, Medicaid is known as DenaliCare, and is managed by the State’s Department of Health, under the Division of Public Assistance. There are also private standalone dental or vision plans you may be able to purchase, such as through an employer, offered as a retirement benefit option.

If Medicaid or a private plan is not an option, you might also use a low-cost dental resource, such as through the Alaska Dental Society and/or the United Way, at colleges such as the University of Alaska Anchorage’s dental clinic, or your local Federally Qualified Health Center (there are over 160 across Alaska – check to see if they offer services on a sliding scale fee). For visually impaired seniors, consider contacting the Alaska Center for the Blind and Visually Impaired or your local Federal Qualified Health Center. Resources mentioned are not all inclusive, and additional assistance may be able to help in your particular situation.

Long-term care

Long-term care refers to a range of services and support that help you perform everyday activities. Long-term care can be provided in a nursing home, assisted living facility, or other setting. Long-term care may include medical care, therapy, 24-hour care, personal care, and custodial care, also called homemaker services. Medicare does not cover non-medical long-term care services. However, if you need care, there are other organizations and forms of insurance you can try.

Medicaid is the country’s largest payer of long-term services and supports and will pay for nursing home care. Medicaid benefits also coordinate with Medicare. Consider long-term care insurance, which generally covers nursing care and custodial care. Note that these plans can be very expensive, and you can only purchase certain long-term care policies if you are in good health. In addition to Medicaid and long-term care policies, you might find local resources that can help with your long-term care needs. I recommend contacting your local Aging and Disability Resource Center, which may have programs that deliver meals or provide transportation. Also, the Alaska Long-Term Care Ombudsman has resource options to consider.

Limits of Medicare Advantage plans

Routinely through television commercials, emails, and printed advertisements, you may see Medicare Advantage plans offering dental coverage, vision coverage, and other supplemental benefits beyond Original Medicare. While we see these ads here in Alaska, there are currently no similar Medicare Advantage plans available for purchase by our residents. And there are often specific rules and restrictions around such supplemental benefits. Often plan marketing materials do not recognize your location when broadcasting the information, so if you do contact someone about these benefits, be sure to let a representative know your home is in Alaska. If you believe Medicare fraud, abuse, or errors occurred, please call our office.

Join the team

If you are part of an agency or organization that assists seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.

For answers to any Medicare related questions, please feel free to contact the State of Alaska’s Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers (MIPPA) program.

Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.

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