Medicare covers a lot — but it doesn’t cover everything. Understanding the gaps is just as important as understanding what’s included. Here’s a clear-eyed look at what Medicare leaves out, and what you can do about it.
Routine Dental Care
Original Medicare doesn’t cover routine dental care — no cleanings, fillings, extractions, or dentures. It will cover dental services that are medically necessary as part of a covered procedure (like jaw surgery), but that’s the exception, not the rule.
Many Medicare Advantage plans include dental benefits, though coverage varies widely and often caps at a low annual maximum. Standalone dental insurance or dental savings plans are the other common options.
Vision
Routine eye exams and eyeglasses are not covered by Original Medicare. Medicare does cover medically necessary eye care — treatment for glaucoma, macular degeneration, diabetic eye disease — but not the annual exam or corrective lenses most people need.
Hearing
Routine hearing exams and hearing aids are not covered. Hearing aids can cost thousands of dollars out of pocket. Some Medicare Advantage plans offer allowances toward hearing aids, but Original Medicare does not.
Long-Term Care
This is one of Medicare’s biggest gaps and the one most people are surprised by. Medicare does not pay for custodial care — the kind of help with daily activities (bathing, dressing, eating) that people need in a nursing home or at home long-term.
Medicare will cover short-term skilled nursing facility care after a qualifying hospital stay, and it covers some home health visits for skilled nursing or therapy. But long-term custodial care is not covered — full stop.
Most Prescriptions (Without Part D)
Original Medicare Parts A and B don’t cover most outpatient prescription drugs. You need a Part D plan or a Medicare Advantage plan with drug coverage to get help with medication costs.
Care Outside the U.S.
Original Medicare generally doesn’t cover healthcare received outside the United States. Some Medigap plans (Plans C, D, F, G, M, and N) include limited foreign travel emergency coverage — 80% of costs after a small deductible, up to a lifetime maximum.
What You Can Do About the Gaps
You have options. A Medigap Supplement plan can eliminate most of the cost-sharing gaps in Parts A and B. A Medicare Advantage plan may bundle dental, vision, and hearing benefits. Separate dental and vision insurance or savings plans can fill specific gaps.
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