Medicare Exclusions

Medicare exclusions refer to the healthcare services and items that are not covered by the Medicare program. These exclusions may vary depending on the specific type of Medicare coverage, such as Medicare Part A, Part B, Part C, or Part D. Some common examples of Medicare exclusions are:

• Cosmetic procedures: Medicare does not cover cosmetic surgeries or procedures, including most dental services, cosmetic injections, or elective plastic surgeries.

• Long-term care: Medicare does not cover custodial care, which includes long-term care in nursing homes, assisted living facilities, or home health services.

• Vision and hearing care: Medicare does not cover routine vision or hearing exams, eyeglasses, or hearing aids. However, some Medicare Advantage plans may offer additional coverage for these services.

• Alternative therapies: Medicare does not cover most alternative therapies, such as acupuncture, chiropractic services, or naturopathic medicine.

• Prescription drugs not on the formulary: Medicare Part D plans may not cover certain prescription drugs that are not on their formulary.

It is important to review the specific coverage and exclusions of your Medicare plan to understand what services and items are covered and what may not be covered.

Next Up

Vision is the most commonly offered ancillary benefit in employer-sponsored plans — 89% of employers offer it nationally, higher than dental, higher than life insurance, and higher than any voluntary benefit. And yet vision is also one of the most underfunded benefits in the market.
Dental benefits are not your largest cost center. For most employers, dental represents a fraction of what medical costs per covered employee annually. But dental is one of the highest visibility benefits in your package: employees use it, notice it, and talk about it. When it’s good, it builds goodwill. When it’s inadequate (low maximums, no orthodontia, zero employer contribution) it registers as a signal that the employer isn’t invested in the total package.
How an employer funds its health plan sits quietly in the background of every benefits decision. Most CHROs and CFOs know their premium cost. Fewer understand the mechanics of how their plan is actually structured: who holds the risk, who administers the claims, how costs flow, and what flexibility, if any, they have to change any of it.