Medicare has clear limits on what it covers, and knowing them helps you plan for out-of-pocket costs

Medicare does not cover long-term care, most dental work, vision care, hearing aids, or routine foot care. It also does not pay for cosmetic surgery, most prescription drugs without a separate Part D plan, or care provided outside the United States. The gaps are significant enough that many people buy supplemental insurance or enroll in a Medicare Advantage plan to fill them. Understanding what falls outside Medicare's scope helps you budget realistically and avoid surprise bills.

The coverage limits exist because Medicare was designed to cover acute medical care — treatment for illness and injury — not ongoing support for daily living or preventive services that fall outside that definition. That distinction matters when you are deciding whether to add coverage or set aside savings.

Key Takeaways

  • Long-term care in a nursing home, assisted living facility, or your own home is not covered by Medicare, even if a doctor prescribes it.
  • Dental care, including cleanings, fillings, and extractions, is not covered unless the procedure is part of a hospital stay.
  • Hearing aids, eyeglasses, and most routine eye exams are not covered, though Medicare Part B covers some diabetic eye exams and glaucoma screening.
  • Prescription drugs are not covered under Part A or Part B; you need Part D or a Medicare Advantage plan that includes drug coverage.
  • Care received outside the United States is not covered, with rare exceptions for emergencies in Canada or Mexico near the U.S. border.

Long-term care and custodial support at home or in facilities

Medicare does not pay for long-term care — the ongoing help with bathing, dressing, eating, and toileting that many people need as they age. This applies whether you receive care in a nursing home, assisted living facility, or your own home. Even if your doctor says you need it, Medicare will not cover it.

Medicare Part A does cover skilled nursing care for a limited time after a hospital stay — up to 100 days per benefit period, with you paying a daily copay after day 20. But that is different from long-term custodial care. Skilled nursing means you need medical care or rehabilitation that only a nurse or therapist can provide. Custodial care means help with activities of daily living, which is not a medical service in Medicare's definition.

If you need long-term care, you typically pay out of pocket, use Medicaid (which does cover it, though with strict income and asset limits), or rely on long-term care insurance if you bought a policy before you needed it. Some people use a combination: they spend down their savings until they may have access to for Medicaid, or they use home care paid privately while they are still working or have savings.

Dental care, including cleanings and tooth extraction

Medicare does not cover routine dental care — cleanings, fillings, root canals, crowns, or extractions. It does not cover dentures or dental implants either. The only exception is if you need dental work as part of a hospital stay; the hospital may cover it as part of your inpatient treatment, but that is rare.

Some Medicare Advantage plans (Part C) include dental coverage, though usually with limits on what they will pay and how often you can visit. If you have Original Medicare (Part A and Part B), you have no dental coverage unless you buy a standalone dental plan from a private insurer. These plans are separate from Medicare and have their own premiums, deductibles, and coverage rules.

Many dental plans have a waiting period before they cover major work like crowns or root canals, so if you know you need dental care, buying a plan early matters. Others cover preventive care (cleanings and exams) at no cost but require you to pay a percentage of the cost for fillings or extractions.

Vision care, eyeglasses, and hearing aids

Medicare Part B does not cover routine eye exams, eyeglasses, or contact lenses. It does cover certain eye exams if you have diabetes (a dilated eye exam to check for diabetic retinopathy) or if you are at risk for glaucoma, but only once per year. If you need glasses or contacts, you pay the full cost yourself.

Hearing aids are not covered by Medicare at all — not the device, not the fitting, not the follow-up adjustments. You pay the full cost, which typically ranges widely depending on the type and where you buy it. Some Medicare Advantage plans include hearing aid coverage or discounts, so it is worth checking your plan's details if hearing loss is a concern for you.

Like dental care, you can buy a standalone vision or hearing plan from a private insurer, but these are separate from Medicare. Some plans cover eye exams and a discount on glasses; others cover hearing aids at a reduced cost. The coverage and cost vary widely, so compare plans if you know you will need these services.

Prescription drugs without Part D or a Medicare Advantage plan

Medicare Part A and Part B do not cover prescription drugs. If you take medications, you need either Part D (a prescription drug plan you add to Original Medicare) or a Medicare Advantage plan that includes drug coverage. Without one of these, you pay the full pharmacy price for every prescription.

Part D plans vary in which drugs they cover, how much you pay, and whether there is a coverage gap (sometimes called the "donut hole") where you pay more out of pocket. You can enroll in Part D when you first become may be able to access for Medicare, or during the annual enrollment period in October and November. If you do not enroll when you are first may be able to access and you do not have other creditable drug coverage, you may pay a penalty when you do enroll.

Medicare Advantage plans that include drug coverage handle prescriptions differently — you typically use the plan's pharmacy network and pay a copay or coinsurance. The drugs covered and the costs depend on the specific plan, so compare plans during open enrollment to see which one covers the medications you take at the lowest cost.

Cosmetic surgery and elective procedures

Medicare does not cover cosmetic surgery — procedures done solely to improve appearance, such as facelifts, liposuction, or hair transplants. It also does not cover most elective procedures that are not medically necessary, such as routine circumcision in adults or most fertility treatments.

The line between cosmetic and medically necessary can be blurry. For example, Medicare may cover eyelid surgery if drooping eyelids interfere with your vision, but not if it is purely for appearance. If you are unsure whether a procedure is covered, ask your doctor to contact Medicare before you schedule it. You can also call Medicare directly at 1-800-MEDICARE to ask about a specific procedure.

Care received outside the United States

Medicare generally does not cover medical care you receive outside the United States, with very limited exceptions. If you are traveling and need emergency care, Medicare will not pay for it. You are responsible for the full cost, which can be substantial in countries with high healthcare prices.

The only exceptions are emergencies in Canada or Mexico if you are traveling directly to or from Alaska, and some care in Canada if you live near the border and it is closer than U.S. care. Even then, Medicare covers only what it would cover in the United States, and you must meet specific conditions. If you travel internationally, consider buying travel health insurance that covers emergency care abroad.

Routine foot care and other preventive services

Medicare does not cover routine foot care — cutting toenails, removing corns or calluses, or general foot exams — even if you have diabetes. The exception is if you have diabetes and your doctor documents that you have severe diabetic foot disease; then Medicare may cover some foot care. Otherwise, you pay out of pocket or see a podiatrist and pay their fee directly.

Medicare also does not cover routine physical exams or screenings that are not specifically listed in its preventive services. It covers certain screenings — mammograms, colonoscopies, blood pressure checks, cholesterol tests — but not a general "annual physical" just to make sure everything is okay. If your doctor wants to do a comprehensive exam that goes beyond the covered screenings, you may be billed for the extra time or services.

Frequently Asked Questions

Does Medicare cover any dental care at all?

Medicare does not cover routine dental care. The only exception is dental work done as part of a hospital inpatient stay, which is rare. Some Medicare Advantage plans include dental coverage, so check your plan details. Otherwise, you need a separate dental plan or pay out of pocket.

What if I need a hearing aid?

Medicare does not cover hearing aids or the cost of fitting them. You pay the full cost yourself, which varies by type and provider. Some Medicare Advantage plans offer hearing aid discounts or coverage, so review your plan. You can also buy a standalone hearing plan from a private insurer.

Am I covered if I need care while traveling outside the U.S.?

No. Medicare does not cover care outside the United States except in rare cases — emergencies in Canada or Mexico if you are traveling directly to or from Alaska. If you travel internationally, buy travel health insurance that covers emergency care abroad to protect yourself from high out-of-pocket costs.

If my doctor prescribes long-term care, does Medicare cover it?

No. Medicare does not cover long-term custodial care in a nursing home, assisted living facility, or at home, even with a doctor's prescription. Medicare Part A covers skilled nursing care for up to 100 days after a hospital stay, but that is different. For long-term care, you pay privately, use Medicaid if you may have access to, or rely on long-term care insurance.

What happens if I do not enroll in Part D when I first become may be able to access?

If you do not enroll in Part D or another creditable drug plan when you first become may be able to access, you may pay a late enrollment penalty when you do enroll. The penalty is a percentage of the national average Part D premium and is added to your monthly premium for as long as you have Part D coverage.