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What Medicare Does not Cover in Senior Care Communities

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Senior care communities offer a variety of health care services to seniors as well as additional amenities and accommodations for their residents to make life comfortable and as active as possible. While Medicare covers some of the medically necessary health services at the senior care community, it will not cover everything which makes the residents reliable for the remainder of the medical care or treatment charges. Without retirement savings or other health care plans, this can make life very frustrating for seniors who require such medical care at their nursing home or senior living community, or are interested in additional care services.


Assisted Living

Medicare will not cover assisted living charges and fees in most cases and will very rarely cover long-term care. As far as living arrangements for assisted living goes, Medicare will only cover a short-term stay in a skilled nursing facility as the individual recovers from an injury, illness, or injury. Assisted living typically involves the living arrangements as well as routine care such as check-ups, medical treatments, and medications. Once they have fully recovered, they will then have the option for long-term care but out of their own funds.

Custodial Care

While in an assisted living facility or nursing home, many seniors will require custodial care, which is defined as non-medical care services such as housekeeping, taking care of personal needs, grooming, and other non-medical services. Medicare will not pay for such services since they are not medically-related and therefore not deemed medically necessary. While these types of senior living homes do offer the services, residents will need to make arrangements for paying for them with other funds.

Optional Services

Medicare limits their offered services to those which are medically necessary such as medical treatments for an illness or injury; therefore, when a resident chooses an additional optional service which is not necessary to keep them healthy, Medicare excludes it. Such exclusions include alternative care such as acupuncture, homeopathy, acupressure and chiropractic services as well as elective surgery like cosmetic treatments. Dental work is also not covered by Medicare, but there are other health services for seniors that offer discounted dental work that needs to be done.

Routine Visits

Routine visits and check-ups by doctors or nurses are not typically covered by Medicare, with the exception of flu shots and some other vital immunizations. Visits to the optometrist are considered to be routine visits and not medically necessary, and are therefore not covered by Medicare. As an exception to this rule, some conditions will be covered under optometry such as glaucoma or diabetes-related issues.