What Medicare Doesn't Cover (And What to Do About It)

Medicare is excellent coverage for hospital care and doctor visits. But it has real, well-known gaps that surprise many new beneficiaries — often at the worst possible moment. Understanding what Medicare doesn't cover, and planning for those gaps in advance, is one of the most important things you can do before you retire.

The Big Gaps Everyone Should Know

Routine Dental Care

Original Medicare (Parts A and B) does not cover routine dental care. This includes:

• Cleanings, exams, and X-rays
• Fillings, crowns, and bridges
• Tooth extractions
• Dentures
• Most oral surgery

Medicare will cover dental work that is medically necessary as part of another covered service — for example, dental work required before a covered heart valve procedure. But routine dental care is not covered.

This is a significant gap for older adults. Dental disease is directly linked to cardiovascular health, diabetes management, and overall wellbeing. Yet the average senior spends $1,500–$2,500 per year on dental care.

What to do: Many Medicare Advantage plans offer some dental benefits — but read the fine print carefully. Coverage often has annual caps of $500–$2,000 and may only cover basic services. Standalone dental insurance is available, as are dental savings plans (discount plans that provide reduced rates at participating dentists). Community health centers and dental schools also offer care at reduced costs.

Routine Vision Care

Original Medicare does not cover routine eye exams for glasses or contact lenses. It also does not cover eyeglasses or contacts.

Medicare does cover medically necessary vision care — cataract surgery, treatment for glaucoma, and eye exams for people with diabetes (to check for diabetic retinopathy). These are disease-related, not routine.

What to do: Many Medicare Advantage plans include some vision benefit — again, review what's actually covered and the annual allowance. Standalone vision insurance is available and often affordable. Retail chains like Costco, Walmart, and Sam's Club offer competitive pricing on frames and lenses for self-pay patients.

Hearing Aids and Exams

Original Medicare does not cover hearing aids or routine hearing exams. This is particularly consequential because hearing loss is common in older adults and untreated hearing loss is associated with cognitive decline, depression, and social isolation.

Hearing aids are expensive — $3,000–$7,000 or more for a pair. Medicare's silence on this has been a long-standing criticism of the program.

What to do: Some Medicare Advantage plans include hearing benefits. The scope varies widely — some provide a basic allowance toward hearing aids, others have comprehensive hearing programs. Over-the-counter hearing aids became available in 2022 for mild-to-moderate hearing loss and are significantly less expensive than prescription devices. Organizations like the Hearing Loss Association of America maintain resources for finding affordable hearing care.

Long-Term Care

This is the largest and most financially dangerous Medicare gap. Medicare does not pay for custodial care — help with daily activities like bathing, dressing, eating, and transferring — whether in a nursing home or at home. This is often called "long-term care" or "personal care."

Medicare does cover skilled nursing facility care for up to 100 days per benefit period after a qualifying hospital stay, but this is for medically necessary skilled care (wound care, physical therapy, etc.), not custodial care. Once the skilled care need ends, Medicare coverage ends — even if the person still needs help with daily activities.

The average cost of a nursing home in the U.S. is $7,000–$10,000 per month. Without planning, this can quickly deplete retirement savings.

What to do: Long-term care insurance can help cover these costs, though premiums are high and underwriting can be difficult for people with health conditions. Hybrid life insurance/LTC policies are another option. For people with limited assets, Medicaid may eventually cover nursing home care, but the eligibility rules and asset limits vary significantly by state.

Prescription Drugs (Under Part A and B)

Original Medicare Parts A and B do not cover most outpatient prescription medications. This is what Medicare Part D is for. If you have Original Medicare without Part D, you're responsible for all outpatient drug costs.

What to do: Enroll in Part D during your Initial Enrollment Period. If you don't, you may face a permanent late enrollment penalty when you do sign up.

Care Outside the United States

Original Medicare generally does not cover healthcare received outside the United States (with limited exceptions, such as some care in Canada or Mexico if it's closer than a U.S. hospital for emergency care).

If you travel internationally — including cruises — and need medical care, Medicare will not pay those bills.

What to do: Some Medigap plans (Plans D, G, M, and N) cover foreign travel emergency care up to a lifetime limit of $50,000 (with a $250 annual deductible and 20% coinsurance). Travel health insurance is also available for international trips.

Cosmetic Surgery

Cosmetic surgery is not covered. Reconstructive surgery following an accident or mastectomy may be covered — but procedures performed purely for aesthetic reasons are not.

Financial Tools That Help Fill the Gaps

Medigap (Medicare Supplement Insurance): Covers much of the cost-sharing left by Original Medicare — deductibles, copays, and coinsurance. Does not cover the non-covered services (dental, vision, hearing, LTC). Works best when combined with Original Medicare.

Medicare Advantage: Many plans include some dental, vision, and hearing benefits, plus an out-of-pocket maximum. The trade-off is network restrictions and prior authorization requirements.

Standalone insurance: Dental, vision, and hearing coverage can be purchased separately from Medicare.

Medicaid: For those who qualify based on income and assets, Medicaid fills many Medicare gaps and can cover long-term care costs.

State Pharmaceutical Assistance Programs (SPAPs): Some states offer programs that help pay drug costs not covered by Medicare.

Knowing the gaps is step one. The next step is building a plan that addresses the ones most relevant to your health situation and financial circumstances.

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Have questions? Call 1-877-443-3251 for free, no-obligation help from a licensed agent.

This is an educational website and is not affiliated with or endorsed by Medicare or any government agency. We connect consumers with licensed insurance agents who can help with Medicare enrollment. Not all plans or options are available in all areas. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.