Medicare does a lot of heavy lifting when it comes to healthcare for people 65 and older. It covers hospital visits, doctor appointments, some prescription drugs, and a decent range of medical services. But here’s the catch: it doesn’t cover everything. In fact, what Medicare doesn’t cover can surprise a lot of people—and those gaps can get expensive fast if you’re not prepared.
Knowing where Medicare stops and how to fill in those blanks can save you money, reduce stress, and help you avoid major out-of-pocket surprises. So, let’s break down exactly what Medicare doesn’t cover, and more importantly, what you can do about it.
Common Services Medicare Doesn’t Cover
Understanding what Medicare doesn’t cover starts with a quick look at the basics. Medicare is split into different parts:
- Part A covers hospital stays and inpatient care.
- Part B covers doctor visits, outpatient care, and some preventive services.
- Part D handles prescription drugs.
- Part C (also called Medicare Advantage) wraps all of the above into one private plan.
Now, even with all of that, some critical services fall through the cracks.
1. Routine Dental Care
Need a cleaning, cavity filling, or a new crown? You’ll need to pay out-of-pocket or buy separate dental insurance. What Medicare doesn’t cover in dental care includes pretty much anything routine—cleanings, X-rays, dentures, and root canals all fall outside the standard Medicare umbrella.
What to do: Look into standalone dental insurance plans or discount dental plans. Some Medicare Advantage plans include limited dental coverage, so compare options.
2. Vision Exams and Glasses
If you’re thinking Medicare will help with your annual eye exam or a new pair of glasses, think again. Original Medicare doesn’t cover routine vision care or corrective lenses unless you’ve had cataract surgery.
What to do: Some Medicare Advantage plans offer vision benefits, including eye exams and a set allowance for glasses or contacts. Alternatively, pay-as-you-go options at big-box retailers can be a low-cost workaround.
3. Hearing Aids and Exams
Hearing loss is common with age, but what Medicare doesn’t cover includes hearing exams and devices like hearing aids. Considering that hearing aids can run $1,000–$5,000 per ear, this gap hurts.
What to do: Check Advantage plans that include hearing benefits or explore community-based programs that offer hearing aid discounts. Some manufacturers also have payment plans or bundled deals.
4. Long-Term Care
This one trips up a lot of people. Medicare does not cover custodial care—like help with bathing, dressing, or daily living tasks—whether it’s in a nursing home, assisted living, or at home.
What to do: Consider long-term care insurance if you’re still eligible. If that’s out of reach, look into Medicaid eligibility, local aid programs, or hybrid life insurance policies with long-term care riders.
What Medicare Doesn’t Cover in Daily Life
It’s not just medical services. What Medicare doesn’t cover also includes things like:
- Over-the-counter medications
- International healthcare (outside the U.S.)
- Cosmetic surgery
- Routine foot care (unless related to diabetes or serious conditions)
- Concierge medical services or membership-based care
What Medicare Doesn’t Cover (And What to Do About It) with Medigap
One way to plug the holes is with Medigap (Medicare Supplement Insurance). It doesn’t add coverage for things like dental or vision, but it does help with copays, coinsurance, and deductibles from Original Medicare.
What to do: Compare Medigap plans to see if they make sense for your health needs. They don’t replace Medicare; they work alongside it. You’ll pay a monthly premium, but it could save you a lot in the long run.
Medicare Advantage Might Be a Better Fit
If the gaps in traditional Medicare feel like too much, Medicare Advantage (Part C) could be a good alternative. These plans are offered by private insurers and often bundle in extras—like gym memberships, dental, hearing, and vision coverage.
But they vary a lot, so don’t assume every plan includes the perks. Read the fine print before you switch.
How to Stay Ahead of the Coverage Gaps
Instead of waiting until you get hit with an unexpected bill, take a proactive approach:
- Review your plan yearly during Open Enrollment (Oct 15–Dec 7)
- Talk to a Medicare advisor who can walk you through your specific situation
- Compare Advantage and Medigap plans side-by-side
- Budget for uncovered services so you’re not blindsided
The more you know about what Medicare doesn’t cover, the more confident you’ll be managing your healthcare costs.
Know the Gaps, Avoid the Traps
At first glance, Medicare feels like a safety net. But the reality is, it’s not as complete as many people expect. What Medicare doesn’t cover could easily sneak up on you—until you’re stuck paying hundreds or even thousands out of pocket.
But the good news? You’re not powerless. With a little planning, smart research, and the right mix of supplemental coverage, you can stay ahead of the gaps and protect your budget.
Medicare isn’t one-size-fits-all, so build the plan that fits you best.
