Original Medicare covers most major medical needs, but there are real gaps. Some are obvious. Others surprise people every year. Here are 10 things Medicare does not cover, and what you can do about each one.
1. Long-term custodial care
This is the biggest gap, by far. Medicare does not cover long-term care in a nursing home or assisted living facility when the care is custodial (help with bathing, dressing, eating, moving around).
Medicare covers short-term skilled nursing care for up to 100 days after a qualifying hospital stay. After that, you are on your own.
What to do:
- Long-term care insurance, purchased before you need it
- Medicaid for those with limited income and assets
- Home equity through reverse mortgages or HELOCs
- Family caregiving as a last resort
2. Routine dental care
Original Medicare does not cover routine cleanings, fillings, crowns, dentures, root canals, or extractions for healthy teeth. The only dental care Medicare covers is when it is part of a covered medical procedure (like jaw reconstruction after an accident).
What to do:
- Many Medicare Advantage plans include dental coverage with annual allowances of $500 to $2,000
- Stand-alone dental insurance (cheap but limited)
- Discount dental plans (not insurance, but lower prices)
- Dental schools for low-cost work
3. Routine vision care
Original Medicare does not cover routine eye exams for glasses or contacts. It does cover medical eye care like cataract surgery, glaucoma tests, and treatment for diabetic eye disease.
What to do:
- Most Medicare Advantage plans include vision coverage with frame allowances
- Discount programs like VSP Direct or EyeMed Direct
- Big-box retailers like Walmart, Costco, and Sam's Club for low-cost glasses
4. Hearing aids
Original Medicare does not cover hearing aids or routine hearing exams. Medicare covers diagnostic hearing tests when a doctor orders one to diagnose a medical problem.
What to do:
- Medicare Advantage plans often include hearing aid allowances of $500 to $2,500
- Direct-to-consumer hearing aids from Costco, Walmart, or online retailers
- Over-the-counter hearing aids became legal in 2022 and cost $200 to $1,000
- Programs like Lions Club or state assistance for low-income seniors
5. Most prescription drugs (without Part D)
Original Medicare Part B covers a small list of drugs administered by a doctor, like chemotherapy infusions or certain injections. It does not cover most prescriptions you fill at a pharmacy.
For pharmacy drugs, you need Medicare Part D, either as a stand-alone plan or bundled with a Medicare Advantage plan.
What to do:
- Enroll in Part D when you first become eligible for Medicare
- If you missed it, enroll during the next Annual Enrollment Period
- If you have low income, apply for Extra Help (see our guide)
6. Care outside the United States
Original Medicare does not cover medical care outside the US except in three narrow situations involving the Canadian border, emergencies near Alaska, and a few cruise ship rules. See our Medicare and travel guide.
What to do:
- Most Medigap plans include a foreign travel emergency benefit (80% of emergency care, $50,000 lifetime cap)
- Travel insurance with medical coverage for trips
- Some Medicare Advantage plans have limited international emergency coverage
7. Cosmetic surgery
Medicare does not cover cosmetic procedures like facelifts, tummy tucks, or breast augmentation. Medicare covers reconstructive surgery when it is medically necessary after an accident, mastectomy, or congenital condition.
What to do:
If a procedure is purely cosmetic, you pay out of pocket. Some procedures might qualify if there is a medical need (like ptosis surgery for drooping eyelids that affect vision).
8. Most acupuncture and chiropractic care
Medicare covers acupuncture only for chronic lower back pain, and only up to 12 visits in 90 days (plus 8 more if there is improvement). Acupuncture for headaches, joint pain, or other conditions is not covered.
Medicare covers chiropractic care only for manual manipulation of the spine to correct a subluxation. X-rays, massage, and other chiropractic services are not covered.
What to do:
- Some Medicare Advantage plans cover broader acupuncture and chiropractic benefits
- Out-of-pocket payment for additional sessions
- HSA or FSA money for qualifying treatments
9. Most routine foot care
Medicare does not cover routine foot care like cutting toenails, removing corns, or trimming calluses for most people. It does cover foot care for people with conditions like diabetes that affect circulation in the feet.
If you have diabetes, ask your doctor for a referral for diabetic foot care. Medicare covers a yearly foot exam plus therapeutic shoes or inserts for diabetics.
What to do:
- If you have diabetes or peripheral artery disease, get a referral for covered foot care
- Out-of-pocket for routine pedicures
- Some Medicare Advantage plans expand foot care
10. Hearing exams for glasses, dental, hearing fittings
This is the smaller cousin of items 2, 3, and 4. Routine exams to fit, calibrate, or order corrective devices are usually not covered.
Medicare WILL cover diagnostic exams when a doctor is checking for a medical problem (cataracts, glaucoma, hearing loss from a stroke).
What about Medicare Advantage?
Many of these gaps are filled by Medicare Advantage plans. A good Medicare Advantage plan in your area might include dental, vision, hearing, gym membership, OTC allowance, and transportation. The trade-off is the plan's network and prior authorization rules.
For more on this trade-off, see our Medicare Advantage vs Medigap guide.
What about Medigap?
Medigap (Medicare Supplement) plans cap your out-of-pocket on covered Medicare services. They do not add coverage for things Medicare doesn't cover. So Medigap does not cover dental, vision, hearing, or long-term care.
Medigap members often buy stand-alone dental, vision, or hearing insurance to fill those gaps.
The bottom line
Medicare's gaps are real, but for each one there is usually a path forward. The two biggest threats are long-term care and prescription drugs. Plan ahead for both before you need them.
The smaller gaps (dental, vision, hearing, acupuncture) are mostly about budgeting. Either pick a Medicare Advantage plan that includes them, or build a small monthly budget for out-of-pocket spending.
