July 2022: Long-term Care and Medicare

Excluded from Medicare Coverage:  Long-Term Care, Dental, and Vision


Long-term care and Medicare

Long-term care (LTC), also called long-term services and supports (LTSS), refers to a range of services that help you perform everyday activities. LTC can be provided in a nursing home, assisted living facility, or other setting, and may include medical care, therapy, 24-hour care, personal care, and custodial care (homemaker services). Medicare usually does not cover non-medical, or non-skilled, LTC 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. Contact your local Medicaid office to see if you are eligible for Medicaid in your state.
  • Long-term care insurance generally covers nursing home care and custodial care. Note that LTC policies can be very expensive, and you can only purchase some LTC policies if you are in good health.
  • An Area Agency on Aging (AAA) may be able to provide counseling and connect you with services in your area.
  • Local Senior centers may have programs that can deliver meals, provide transportation and shopping assistance, and offer case management. Call your local AAA to find senior centers in your area.
  • Geriatric care managers are health and human service professionals who work privately with you and your family to create a plan of care that meets your needs.


Dental services and Medicare

Medicare does not cover dental services that you need primarily for the health of your teeth, such as routine checkups, cleanings, fillings, and dentures. Medicare does, however, offer very limited coverage for dental care needed to protect certain 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
  • Dental splints and wiring needed after jaw surgery
  • Removal of a tooth in order to access and treat a cancerous growth


Vision services and Medicare

Routine eye care services, such as regular eye exams, are excluded from Medicare coverage. However, Medicare does cover certain eye care services if you have a chronic eye condition, such as cataracts or glaucoma. Medicare covers:

  • Surgical procedures to help repair the function of the eye due to chronic eye conditions.
    • For example, Medicare will cover surgery to remove a cataract and replace your eye’s lens with a fabricated intraocular lens.
  • Eyeglasses or contacts if you had an intraocular lens placed in your eye after cataract surgery.
  • An eye exam to diagnose potential vision problems.

Medicare only covers annual eye exams by state-authorized eye doctors if you have diabetes or are at high risk for glaucoma.


How to access dental and vision care

Although most dental and vision care is excluded from Medicare coverage, you can access this care in other ways:

  • Medicare Advantage Plans: Some Medicare Advantage Plans offer routine dental and/or vision coverage as supplemental benefits. Contact the plan to learn about services it may cover, any rules or restrictions, and costs.
  • Medicaid: In some states, Medicaid covers some dental and vision services. You may qualify for Medicaid if you have limited income and assets. Contact your local Medicaid office for more information.
  • Private plans: You can purchase a separate dental and/or vision plan from a private company.
  • Federally Qualified Health Centers (FQHCs): FQHCs are health care facilities located in medically underserved areas. Some FQHCs may offer dental or vision care.
  • Community Health Centers (CHCs): CHCs provide free or reduced-cost health services, including dental care and sometimes vision care.
  • Dental and optometry schools: Some schools provide low-cost dental care. Dental and optometry students work with patients under the supervision of licensed professionals.