Key Takeaways

• Medicare covers a wide range of medical services, but it doesn’t include everything you might expect. Some essential services—like dental, vision, and long-term care—often require separate coverage.

• Understanding what’s not covered can help you avoid costly surprises and plan more effectively. Many beneficiaries explore supplemental policies to fill these gaps.

Medicare Has Clear Limits—And They Matter

When you enroll in Medicare, it’s natural to assume you’re getting complete coverage. After all, it’s the nation’s primary health insurance program for people age 65 and older, as well as some younger individuals with disabilities. But the reality is more complex.

Original Medicare (Parts A and B) provides coverage for many hospital and medical services, but there are critical areas where it falls short. Even when you add Part D for prescription drugs, you may still be left exposed to certain healthcare expenses that aren’t part of the package.

If you don’t know what Medicare leaves out, it can lead to surprise bills and gaps in your care.

What Original Medicare Does Cover

Before we go into what’s not covered, let’s be clear about what is:

• Part A covers inpatient hospital care, skilled nursing facility care (with limitations), hospice care, and some home health services.

• Part B covers outpatient services like doctor visits, lab tests, durable medical equipment, preventive screenings, and certain home health care services.

• Part D offers prescription drug coverage, typically through a separate plan.

These parts make up the foundation of Medicare, but they don’t include everything you may need for your full health picture.

Services Medicare Commonly Excludes

Several essential services are not included in Original Medicare. You may need to find other ways to cover them or pay out of pocket.

1. Long-Term Custodial Care

Medicare does not cover most long-term care services that assist with activities of daily living, such as:

• Bathing

• Dressing

• Using the bathroom

• Meal preparation

While Medicare does pay for limited skilled nursing facility care—up to 100 days after a qualifying hospital stay—it does not cover extended stays or ongoing personal care.

2. Routine Dental Services

Dental health is a major part of your overall well-being, but Medicare generally does not cover:

• Routine dental exams

• Cleanings

• Fillings

• Crowns

• Dentures

If you need these services, you will need to pay out of pocket or enroll in a separate dental insurance plan.

3. Vision Care

While Medicare may cover eye exams for certain conditions like glaucoma or diabetic retinopathy, it doesn’t cover routine vision services, including:

• Eye exams for glasses or contact lenses

• Eyeglasses

• Contact lenses

This is a common area where retirees seek separate vision coverage.

4. Hearing Aids and Hearing Exams

Hearing loss is common with age, but Medicare does not cover hearing aids or routine hearing exams. Only diagnostic hearing and balance exams that your doctor orders to determine if medical treatment is needed are typically covered.

Hearing aids and fittings must be paid out of pocket or through other coverage.

5. Overseas Medical Care

Medicare coverage doesn’t follow you abroad. If you travel outside the United States and need care, Original Medicare will generally not cover any of the expenses, except in very limited emergency situations near U.S. borders or certain cruise ships.

You may need travel medical insurance or a supplemental plan with foreign travel emergency benefits.

6. Most Foot Care Services

Routine foot care—including nail trimming and callus removal—is not covered by Medicare. Exceptions apply only when treatment is deemed medically necessary due to a condition like diabetes or circulatory disease.

7. Cosmetic Procedures

Medicare does not cover cosmetic surgeries or procedures unless they are needed to improve function or correct a deformity caused by trauma, disease, or congenital conditions.

This includes:

• Botox for cosmetic purposes

• Facelifts

• Breast augmentation (unless medically necessary)

8. Acupuncture (With Some Exceptions)

Medicare covers acupuncture only for chronic lower back pain. Other conditions—like migraines or arthritis—are not covered. If you use acupuncture for general wellness, you’ll need to pay on your own.

9. Alternative and Holistic Therapies

Services like massage therapy, naturopathy, chiropractic care (beyond limited spinal manipulation), and homeopathy are not generally covered.

Even though these are growing in popularity, Medicare doesn’t recognize them as medically necessary for coverage.

10. Prescription Drugs Without Part D

You must actively enroll in a Part D plan if you want coverage for most outpatient prescription drugs. If you skip this, you’ll be paying full price for your medications, and you may face a permanent penalty if you enroll late.

Cost Sharing and Gaps in Coverage

Even for the services Medicare does cover, you still have to pay:

• Deductibles: In 2025, the Part A deductible is $1,676 per benefit period, and the Part B deductible is $257 annually.

• Coinsurance: You pay a share of the costs for many services. For example, under Part B, you typically pay 20% of the Medicare-approved amount.

• Out-of-pocket caps: Original Medicare does not have a maximum limit on what you may spend each year. That means your potential costs are open-ended unless you add other protection.

What Can Help Fill the Gaps?

To reduce your financial exposure, many people add coverage beyond Original Medicare. Your options include:

Medicare Supplement Insurance (Medigap)

These standardized plans help pay for out-of-pocket costs like deductibles, coinsurance, and copayments. Some also offer limited foreign travel emergency coverage. You must already have Parts A and B to buy one.

Keep in mind that timing matters: the best time to enroll is during your Medigap Open Enrollment Period, which lasts for 6 months starting the month you turn 65 and enroll in Part B.

Medicare Advantage Plans (Part C)

Medicare Advantage plans often include extra benefits such as dental, vision, hearing, and prescription drug coverage. However, they come with their own networks and cost-sharing structures.

These plans are administered by private companies, and you must continue paying your Part B premium to stay enrolled.

Standalone Coverage

Some people purchase standalone dental, vision, or hearing plans to handle the specific services Medicare does not include.

You should also consider:

• Long-term care insurance

• Travel insurance for healthcare abroad

• Prescription discount programs if you don’t have Part D

When to Review and Adjust Your Coverage

There are key times in the year when you can make changes to your Medicare coverage:

• Initial Enrollment Period (IEP): Around your 65th birthday.

• Open Enrollment (October 15 – December 7): You can switch between Original Medicare and Medicare Advantage or change Part D plans.

• Medigap Open Enrollment: A one-time six-month window starting when you’re 65 and enrolled in Part B.

• Special Enrollment Periods (SEP): Triggered by certain life events like moving, losing other insurance, or qualifying for extra help.

If your healthcare needs change, it’s worth reviewing your plan each year during these windows.

It’s Not Just About Coverage—It’s About Awareness

Many people don’t realize the limitations of Medicare until they’re facing an uncovered bill. The more you know about what isn’t included, the better prepared you are to avoid costly oversights.

Get clarity now and think ahead. Ask yourself:

• Do I need routine dental or vision care?

• Am I likely to need hearing support?

• Could I need long-term custodial care in the future?

• Will I travel outside the U.S.?

These questions help shape the type of supplemental coverage you might need.

Understanding What Medicare Leaves Out Puts You in Control

Knowing what Medicare does and doesn’t cover helps you plan smarter, spend wiser, and avoid unwelcome financial surprises. While it’s a strong foundation for health coverage, you’re responsible for filling in the rest.

For personalized help choosing the right coverage options that match your health and lifestyle needs, speak with a licensed agent listed on this website. The right advice can help you protect both your health and your savings.