What Medicare Does NOT Cover — And How to Fill the Gaps

When people first sign up for Medicare, the question I hear most often is: "So this covers everything, right?"

Not quite. Medicare Parts A and B cover a wide range of hospital and medical services, but there are some significant — and expensive — gaps that catch beneficiaries off guard every year. Understanding what Medicare does not cover is just as important as understanding what it does.

The Big Six Coverage Gaps

1. Routine Dental Care#

Medicare does not cover most dental services. That includes routine exams and cleanings, fillings, crowns, bridges, dentures, and tooth extractions (unless medically necessary for another covered procedure).

The average cost of a single dental crown in 2026 is $1,000–$1,500. Full dentures can run $1,500–$3,500 per arch. These are out-of-pocket expenses unless you have supplemental dental coverage.

What helps: Standalone dental insurance plans, Medicare Advantage plans with dental benefits included, or discount dental plans for lower-cost routine care.

2. Routine Vision and Eyeglasses#

Standard Medicare does not cover routine eye exams for glasses or contact lenses, nor the glasses and contacts themselves. (It does cover eye exams related to medical conditions like glaucoma, diabetic retinopathy, and macular degeneration.)

A standard eye exam runs $100–$200. New frames and lenses can add another $200–$600 or more. Multiply that over a few years and it adds up quickly.

What helps: Many Medicare Advantage plans include a routine vision benefit with an allowance for frames and lenses. Standalone vision plans are another option.

3. Hearing Aids and Exams#

This is one of the most commonly overlooked gaps. Original Medicare does not cover hearing exams for fitting hearing aids, and it does not cover hearing aids themselves.

The average cost of a pair of hearing aids in 2026 is between $4,000 and $7,000 — and most people need two. This single gap has driven many beneficiaries to choose Medicare Advantage specifically for its hearing benefits.

What helps: Many Medicare Advantage plans include annual hearing aid allowances ranging from $500 to $2,500 per year.

4. Long-Term Custodial Care#

Medicare covers skilled nursing facility care following a qualifying hospital stay, but only for up to 100 days — and with significant cost-sharing after day 20. What Medicare does not cover is custodial care: help with daily activities like bathing, dressing, eating, and toileting in a nursing home or at home.

This is a major financial exposure. Nursing home care in Florida averages over $8,000 per month in 2026. Home health aide services run $25–$35 per hour.

What helps: Long-term care insurance, hybrid life/LTC policies, and in some cases Medicaid (for those who qualify). This is a planning conversation worth having well before age 65.

5. Care Outside the United States#

Original Medicare almost never covers care you receive outside the U.S. If you travel internationally, a medical emergency abroad is an out-of-pocket expense — often a significant one.

What helps: Some Medigap (Medicare Supplement) plans — specifically Plans C, D, F, G, M, and N — include a foreign travel emergency benefit that pays 80% of medically necessary emergency care outside the U.S., up to a lifetime maximum of $50,000 after a $250 deductible.

6. Routine Foot Care#

Medicare does not cover most foot care, including routine nail trimming, callus removal, and flat-foot treatment. It does cover foot care related to diabetic peripheral neuropathy and other medical conditions — but the purely routine stuff is out-of-pocket.

What About the Medicare Cost-Sharing You Still Owe?

Even for services Medicare does cover, there are deductibles, coinsurance, and copays that can add up quickly. In 2026:

• Part A deductible: $1,676 per benefit period (not per year)
• Part B deductible: $257 per year
• Part B coinsurance: 20% of all approved services — with no cap

That 20% coinsurance with no out-of-pocket maximum is one of the most important gaps of all. A $100,000 hospitalization could leave you owing $20,000 after Medicare pays its share.

What helps: A Medicare Supplement (Medigap) plan pays most or all of this cost-sharing, depending on the plan type. Plan G is the most popular choice for new Medicare enrollees in 2026.

The Practical Solution: Know Before You Enroll

The best time to review your options is before your Initial Enrollment Period closes — that is, in the seven-month window around your 65th birthday. During that window, you have guaranteed issue rights for Medigap plans, meaning carriers cannot deny you coverage or charge you more for pre-existing conditions.

If you have already enrolled and are looking at changing plans, there are specific windows and rules that apply.

The right approach depends on your health, budget, how much you travel, and which services matter most to you. There is no single "best" plan — there is only the right fit for your situation.

Curious which coverage gaps matter most for your lifestyle? Schedule a no-cost consultation and we will walk through your specific situation, compare options side by side, and make sure you are not caught off guard by a gap that could have been covered.

Licensed in Florida, Alabama, Georgia, and North Carolina.

Frequently Asked Questions#

Does Medicare cover dental implants? No. Dental implants are not covered by Original Medicare. Some Medicare Advantage plans include dental benefits that may cover implants partially, but coverage varies significantly by plan.

Does Medicare cover glasses after cataract surgery? Yes — one pair of eyeglasses or contact lenses after cataract surgery that implants an intraocular lens is covered by Medicare Part B.

Can I get hearing aids through Medicare? Original Medicare does not cover hearing aids. However, many Medicare Advantage plans include an annual hearing aid benefit. Coverage and allowances vary widely by plan and location.

What is the best way to cover Medicare's gaps? Most beneficiaries choose either a Medicare Supplement (Medigap) plan to cover Original Medicare's cost-sharing, or a Medicare Advantage plan that bundles extra benefits like dental, vision, and hearing. Each approach has tradeoffs worth understanding before you choose.