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What services are not covered under Medicare Part B? 


| Many services you’ve come to rely on when you received insurance through your employer won’t be paid for using original Medicare, the two-part program that then-President Lyndon B. Johnson signed into law in 1965.

Part A provides coverage for inpatient stays in hospitals and skilled nursing facilities, some home care and end-of-life hospice care.

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Part B covers doctors’ services, diagnostic screenings, lab tests, outpatient care, and some medical equipment and transportation. It also covers a variety of preventive measures — screenings, tests and vaccines — at no cost to you.

What are the details of what Part B won’t pay for?

Part B doesn’t cover everything, including several doctor and outpatient services.

  • Care not considered medically necessary, such as elective cosmetic surgery or weight loss procedures, unless you meet certain conditions associated with morbid obesity
  • Chiropractor or acupuncture visits, unless you meet very specific criteria. It won’t cover regular maintenance or preventive chiropractic visits or treatments to other parts of the body.

Part B covers only manual manipulation of the spine considered medically necessary to correct a subluxation, a dislocation or misalignment of the vertebrae. It covers acupuncture only if you’ve experienced low back pain for at least 12 weeks.

  • Most prescription drugs. Part D covers many of the doctor-prescribed medicines you take yourself as well as insulin you inject yourself and related supplies. Part B does cover drugs administered in a doctor’s office or outpatient clinic, such as most infused and injectable medications, and those delivered through durable medical equipment, including insulin from an external infusion pump that you reuse.
  • Routine foot care, but it covers therapeutic shoes and accompanying orthotic inserts and some foot exams for people with diabetes
  • Some vaccinations, such as the shingles vaccine that Part D covers. Others, including flu, hepatitis B and pneumonia shots, are a Part B free preventive service.

Do Medicare Advantage or Medigap cover these services?

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Yes, in some cases. Most Medicare Advantage plans provide some dental, hearing and vision coverage. Many also cover gym memberships and fitness programs.

Medicare Advantage plans are a private alternative to original Medicare. By law, they must cover the same services as Part A and Part B but often have different out-of-pocket costs and usually include extra benefits.

To find a Medicare Advantage plan with these benefits, go to the Medicare Plan Finder and type in your zip code and check Medicare Advantage Plan. You can type in your medications or go directly to a list of Medicare Advantage plans in your area. In the Plan Benefits box, you’ll see green check marks noting plans that offer vision, dental, hearing or fitness benefits. For more information about these benefits, click Plan Details and scroll down to Extra Benefits. You can visit the plan’s website or contact the plan directly for more information.

Unlike original Medicare, Medicare Advantage plans generally have provider networks, and they may charge more or may not cover doctors, facilities or other providers outside the plan’s network. You may also need a referral from your primary care doctor to see a specialist. Contact the plan to find out if the providers you want are covered, to avoid being denied.

If you have original Medicare, you may get coverage for a package of extra benefits by buying a Medicare supplemental plan, also called Medigap. These plans help pay Medicare’s deductibles and copayments, and some plans also offer dental discounts, hearing and vision care, and gym membership.

Keep in mind

If Medicare denies a claim that you believe should have been covered as a medically necessary service, you have several levels of appeals. Check your Medicare Summary Notice, the claims statement you receive from Medicare, for more information about whether it paid your claims and the steps for appealing a denial.

Updated December 16, 2022

 

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