The gaps in Medicare coverage

Medicare covers a lot, but it has clear limits. It does not pay for dental work, hearing aids, eyeglasses, or most long-term care. It does not cover routine foot care, most cosmetic surgery, or experimental treatments. It does not pay for travel outside the United States, and it does not cover most prescription drugs unless you are enrolled in a Part D plan. Understanding what is not covered matters because you will pay the full cost yourself — and those costs can be substantial.

The gaps fall into a few categories: services Medicare straightforward does not cover at all, services it covers only under specific conditions, and services where you pay a share even though Medicare does cover them. Knowing which category applies to you helps you plan and budget.

Key Takeaways

  • Medicare does not cover dental care, hearing aids, eyeglasses, or routine foot care, and you pay the full cost of these services yourself.
  • Long-term care in a nursing home or assisted living is not covered by Medicare, though it may cover short-term skilled nursing care after a hospital stay.
  • Prescription drugs are not covered under Original Medicare unless you enroll in a Part D plan, and costs vary by plan and by drug.
  • You pay a portion of most covered services through deductibles, copayments, and coinsurance, even with Medicare coverage.
  • Medigap and Medicare Advantage plans can cover some of these gaps, but they have their own costs and limits.

Dental, vision, and hearing — what you pay in full

Medicare does not cover routine dental care, dental surgery, dentures, or dental implants. This includes cleanings, fillings, root canals, and extractions. If you need dental work, you pay the entire bill. Some dental schools offer reduced-cost care, and some community health centers have sliding-scale dental clinics, but Medicare itself will not reimburse you.

Eyeglasses and contact lenses are not covered. Medicare covers the eye exam that detects glaucoma or other eye disease, but not the exam for a glasses prescription, and not the glasses themselves. Hearing aids are not covered either. A hearing test may be covered if it is part of diagnosing a medical condition, but the hearing aid device and fitting are your responsibility. Some states offer hearing aid programs for seniors with limited income, and some hearing aid companies offer payment plans, but Medicare does not pay.

Routine foot care — trimming nails, removing calluses, treating corns — is not covered unless you have a medical condition like diabetes that makes foot care medically necessary. Even then, only a podiatrist or physician can bill Medicare for it, and only if the care is tied to treating the underlying condition.

Long-term care and custodial services

Medicare does not pay for long-term care in a nursing home or assisted living facility. This is one of the largest gaps in coverage. Medicare covers up to 100 days of skilled nursing care after a hospital stay of at least three days, but only if you need daily skilled nursing or rehabilitation — not just help with daily activities. Once those 100 days end, you pay out of pocket.

Custodial care — help with bathing, dressing, eating, and toileting — is not covered by Medicare at any point. If you need this kind of help at home, in a nursing home, or in assisted living, you pay for it yourself. This is where many seniors and their families face unexpected costs. Long-term care insurance, Medicaid (if you meet income limits), or personal savings are the ways people typically cover these costs.

Medicare also does not cover homemaker services, meal delivery, or transportation to medical appointments, even though these services help seniors stay independent. Some Area Agencies on Aging and community programs offer these services at low cost, but Medicare does not.

Prescription drugs without Part D

Original Medicare (Part A and Part B) does not cover prescription drugs. If you did not enroll in a Part D prescription drug plan when you first became may be able to access for Medicare, you will pay the full cost of prescriptions out of pocket. Even with Part D, you pay a monthly premium, and you share the cost of drugs through copayments or coinsurance.

Part D plans vary widely in which drugs they cover and how much you pay. Some drugs are covered; others are not. Some require you to try a cheaper drug first before the plan will cover a more expensive one. Costs also change from year to year, and the drugs covered by your plan may change. You can switch Part D plans once a year during the annual enrollment period in the fall.

If you did not sign up for Part D when you were first may be able to access and you do not have other creditable drug coverage, you may face a late enrollment penalty — a permanent increase to your Part D premium — if you join later.

What you pay even when Medicare covers it

Medicare covers many services, but you still pay a share. Under Original Medicare, you pay a deductible before coverage begins, and then you pay coinsurance (a percentage of the cost) for most services. For hospital stays, you pay a deductible for each benefit period. For doctor visits and outpatient services, you pay 20 percent coinsurance after you meet the deductible.

These costs add up. If you have a serious illness or need frequent medical care, your out-of-pocket costs can reach thousands of dollars in a year. This is why many seniors buy Medigap insurance (also called supplemental insurance) to cover the deductibles and coinsurance that Original Medicare does not pay. Medigap has its own monthly premium, but it can reduce your out-of-pocket costs significantly.

If you have Medicare Advantage (Part C), you typically pay lower premiums than Original Medicare plus Medigap, but you may have higher copayments and coinsurance for each service, and you may face limits on which doctors and hospitals you can use.

Experimental treatments and services outside the United States

Medicare does not cover experimental or investigational treatments — treatments that have not yet been approved by the Food and Drug Administration or that are being tested in a clinical trial. If your doctor recommends an experimental treatment, you would pay for it yourself, though some clinical trials cover their costs.

If you travel outside the United States, Medicare does not cover care you receive there, with rare exceptions. If you are in a country bordering the United States (Canada or Mexico) and the nearest hospital is in that country, Medicare may cover emergency care. Otherwise, you pay the full cost. Travel insurance that covers medical care abroad is available but is separate from Medicare.

Medicare also does not cover cosmetic surgery unless it is medically necessary — for example, reconstructive surgery after an injury or illness. Elective cosmetic procedures are your responsibility.

How to plan for gaps in coverage

Start by listing the services you use or expect to use: dental care, glasses, hearing aids, prescription drugs, or long-term care. Then find out what each costs in your area. For dental and vision, call local providers for price estimates. For prescription drugs, use the Medicare Plan Finder tool on Medicare.gov to see what Part D plans cover your specific medications and what you would pay.

For long-term care, talk to your family about what might happen if you need help with daily activities. Long-term care insurance is less expensive when you buy it younger and healthier, but it is not right for everyone. Medicaid covers long-term care for people with limited income and assets, but you have to spend down your savings first. Some people straightforward plan to pay out of pocket or rely on family help.

Consider whether Medigap or Medicare Advantage makes sense for you. Medigap covers many of the gaps in Original Medicare, but it costs more in premiums. Medicare Advantage may have lower premiums but higher copayments and limits on your choice of doctors. There is no single right answer — it depends on your health, your budget, and which services matter most to you.

Frequently Asked Questions

Does Medicare ever cover dental work?

No. Medicare does not cover any routine dental care, including cleanings, fillings, extractions, root canals, dentures, or implants. Some dental schools and community health centers offer reduced-cost dental care on a sliding scale based on income.

Will Medicare pay for a hearing aid?

No. Medicare does not cover hearing aids or the fitting. A hearing test may be covered if it is part of diagnosing a medical condition, but the device itself is not covered. Some states have programs that help seniors with limited income pay for hearing aids.

What happens if I need to stay in a nursing home for more than 100 days?

Medicare covers up to 100 days of skilled nursing care after a hospital stay, but only if you need skilled care like wound care or physical therapy. After 100 days, you pay the full cost yourself. Long-term care insurance, Medicaid, or personal savings are the main ways people cover extended nursing home stays.

Can I use my Medicare coverage if I travel to Canada or Mexico?

Medicare does not cover care outside the United States except in rare cases — for example, if you are in a bordering country and the nearest hospital is there and you need emergency care. If you travel internationally, you should purchase travel insurance that covers medical care.

What should I do if I did not sign up for Part D when I first got Medicare?

You can enroll in a Part D plan during the annual enrollment period (October 15 to December 7 each year). However, if you did not have other creditable drug coverage, you may face a late enrollment penalty — a permanent increase to your Part D premium — for each month you were not enrolled.